20 Episode results for "Professor Of Pediatrics"

You Have To Be 21 To Smoke In Illinois. Will New Law Affect Teen Vaping?

On Point with Tom Ashbrook | Podcasts

50:23 min | 1 year ago

You Have To Be 21 To Smoke In Illinois. Will New Law Affect Teen Vaping?

"Support for on point and the following message. Come from legalzoom legalzoom used by more than four million people for a variety of services from wills and trusts to LLC's and trademarks more information is available at legalzoom dot com slash point. This message comes from on point sponsor, indeed if you're hiring with indeed you can post a job in minutes, set up screener questions then zero in on your shortlist of qualified candidates using an online dashboard get started at indeed dot com slash NPR podcast. From WB. You are Boston and NPR I'm magnetized party. And this is on point nearly one in five high school students reported using e cigarettes last year. That's almost twenty percent of high school students the FDA has gone as far as calling team vaping an epidemic. Now, vape sleek design, fruity flavors and large doses of nicotine can be addictive. But there's little research on how to best treat vaping habits among teens. So now citizen states around the country are trying to clamp down on vaping by raising the minimum purchasing age for tobacco products from eighteen to twenty one will it work, and what did it entire generations worth of an anti tobacco campaigns? Teach us about affective ways to change teen behavior this hour on point tobacco Twenty-one and teen vaping. And you can join us. Are you a teenager who's tried e cigarettes? Are you will worried parent? What is your story will raising the e cigarette age twenty? One make any difference. And what do you think it will take to curb teen vaping? Join us anytime at on point radio dot org or Twitter and Facebook at on point radio now, Illinois just recently raised its tobacco age to twenty one. So let's listen for a moment to Illinois Governor Jay Pritzker who signed the legislation on Sunday here. He is announcing the rule change. This is about the health of our youth and the longevity of our shits. And if there are young people who will travel over state lines to buy tobacco products because they can legally buy them there than I urge the surrounding states to pass tobacco twenty one to Illinois. Governor Jay b Pritzker on Sunday. Joining us now from Chicago is doctor Julie Morita Commissioner for the city of Chicago's department of public health and under her leadership Chicago raise the age for purchasing cigarettes and e cigarettes tobacco products in general to Twenty-one back into. Thousand sixteen as you just heard the entire state of Illinois followed suit this past weekend. Dr Marito welcome to on point. Hi, mike. Thanks for hosting us. So first of all tell us tell us a little bit about what you saw in terms of changes in teen vaping rates in Chicago over the past couple of years that prompted you to to change the purchasing age back in two thousand sixteen. I think our approach for tobacco started before vaping. Even came onto the scene. We recognize that the best way to prevent problems with tobacco related disease was really trying to prevent young people from smoking. And so we implemented a number of different things starting from twenty thirteen. However when we did start seeing that e cigarettes and vaping was becoming a problem. We really did escalate our effort, and so we could see that the trend was rising rapidly. But more and more young people were experimenting with e cigarettes in vaping. And that the rise was really rapid that helped us really motivate others to move forward with instituting tobacco twenty one. And in two thousand sixteen. Jump in here because some of the numbers around tobacco use usage in teens in Chicago's quite remarkable. I mean, I I see that you've written that that Chicago has reduced cigarette. Smoking rates by high school students from a little over thirteen percent, which it was in two thousand eleven down to six percent today. D do you attribute that to raising the the the purchase age to twenty one? I think we know about tobacco youth on youth is that we make these products less affordable less accessible and less attractive to youth. They will be much less likely to purchase these products. And so two thousand thirteen we created a flavored tobacco ban around schools. So that schools couldn't sell mint flavor or candy flavored tobacco products within five hundred feet of high schools. We also increase the price of regular cigarettes by increasing the taxes, and then twenty four team we made Easter as part of our clean indoor act ordinance, which prevents people from these smoking around or inside of buildings, but then we often included these cigarettes in that in that that ban those kinds of efforts along with tobacco twenty one have contributed to the major reduction at least saw and young people smoking cigarette. But that's what we have. We have a reduction of high school students smoking cigarettes that doesn't necessarily reflect their activity as a relief that they being or juuling. Right. Because you say here in a piece that you wrote that e cigarette use by teens is in Chicago is at six point six percents so higher now now than cigarette use that was in two thousand seventeen minutes that time our percentage of kids smoking high school students smoking cigarettes was six percent. And those reported are admitted to vaping are using these cigarettes loose six point six percent. I know I suspect that the rates of young people using e cigarettes vaping is probably higher than that right now. Because it was just a massive explosion of youth. The manufacturers were unbelievably successful in marketing their products to young people, and that's reasonable. We see many many young people that are using these products and actually addicted actually addicted. Okay. So we're gonna talk a little later in the show about about exactly what's in these e cigarettes and why maybe teenage brains are more susceptible to addiction through them. But but have you what have you heard from parents from teachers? Around Chicago about how much more or if they are seeing more e cigarette usage amongst teens. I am appearance. In addition to being a public health official and a pediatrician and I have a sixteen year old who's in high school in Chicago public school. And so I talked to his peers and his peers parents and the teachers in his school, and I know that the juuling vaping is a major problem. And I it's it's it's not just limited to my son's school. When I talked to parents of kids that age and high school or even in middle school across the board. They are concerned about their children being exposed to being taking on the habit of Julie, and the potential health hazards that really poses. So I guess I heard you say a little earlier Morita that not only did did you raise the the purchasing age to twenty one in Chicago or the city of Chicago did that, but there were all these other efforts as well about play, you know, banning places where cigarettes or even e cigarettes could be used. But now, I'm I'm also wondering given what you just said about. The powerful marketing a vaping. And you know companies like jewel will say that they do not intentionally market to words to minors or teens one acknowledge that that's what you would say. But but it does more need to be done beyond the raising of the purchasing age. Definitely I think again, we increase the age of purchasing. We also prohibit the use of these products in the same places that regular other traditional tobacco products are can't be used. And then we also created a acquire moment for warning signs to be posted in retailers establishment. So that they actually put up signs that indicate that e cigarettes tobacco products are hazardous to health the tobacco industry spends billions of dollars to market their products. And though they may claim that they're not marking them toward youth some of these products, you don't create products that are candy flavored mint creme brulee flavored to appeal to adults, and that's really meant to be appealing to us. We don't have those kinds of budgets in the public sector. And so what we've done is we've required that retailers him the city of Chicago put up warning signs that really make it clear that these products are addictive and harmful to health. Well, Dr Julie Morita Commissioner for the Chicago department of public health. Breath and Chicago back in two thousand sixteen raised the purchasing age for tobacco to twenty one. And this hour, we're talking about the fact that a lot of states are following suit as well, Dr Morita thank you so much for joining us today. Thank you. Let's go straight to the phones. Matthew is calling from Richmond Virginia. Matthew, you're on the air. All right. Thanks for taking my call. I just wanted to express just a comment here. I wanted to speak just briefly on kind of how this affect raising the minimum age to twenty one per tobacco products because we pass a similar law here in Virginia. Just recently. I kind of wanted you to briefly discuss how it affects public health as a whole on the long term as well. Because many of the discussions I with my friends about this. They say, well, we're dope. We can make this choice. But they don't really understand how this benefit society of the whole long term. And I know that the pretty broad question. But I just wanted to express the importance of in see what you think about it. Hang a bit for. So you say when you have discussions with your friends. Do they do they use these cigarettes? Do you? Yes, I do rest assured making plans to quit. However, my I do have friends who use tobacco products e cigarettes cigarettes, and sells and some of them will argue a weakened into the military. We can do the lottery we can do all the thank and adult can do. But we shouldn't be able we can't buy tobacco products. If you're under twenty one, and I try to express them the health benefits, but you know, some people prefer their choice instead. Okay. Matthew from Richmond Virginia. Thank you so much for your call. So let's get an answer to Matthew's question about how does it affect the public health at large? Joining us now is Dr Suzanne ten ski. She is a professor of pediatrics at Dartmouth College. She's a tobacco control expert with more than seventeen years of experience, researching tobacco issues and products and council counselling youth who use those products. She's also the former chair of the American Association of pediatrics tobacco consortium, Dr tan ski welcome to on point. Hello, thank you. So. Much for having me. So we had that great coal asking sort of a big picture question about how does raising the tobacco age or purchasing H two twenty one. How does it affect the public health overall? Well, that's a really important issue. So cigarettes are a defective product that used as intended will kill half of the people who are long-term users. So from a public health standpoint stopping people from using tobacco and helping them to quit. Cigarettes is one of the best things. We can do we're going to lose four hundred and forty thousand people in the United States this year to tobacco related deaths. So yes adults can make their own decisions. But this is a product that would never have seen the light of day. If we put product restrictions on cigarettes. Back in the nineteen hundreds when cigarettes were created this is really a defective product. And really it shouldn't. It's not safe for anybody to use until does that seem logic though, apply for e cigarettes and for vaping it. It's an interesting question so cigarettes, again, if if cigarettes are comparison killing half of their long-term users. I don't really like that comparison, I really prefer the comparison to be healthy air, and if we're comparing e cigarettes to combusted tobacco cigarettes, they really are quite different. There are fewer fewer things that are in e cigarettes, but they are not without harm. And there is equal or higher amounts of nicotine in the various products. The products are really different from each other. And we'll get into that in a moment if we have time. So I can't say that one vape is another, and, but we have not gotten away from the ultra fine particles in some of the other byproducts that happen when you heat up the vape that is in them too. High temperatures things break down you have a different characteristic based on flavors based on. The nicotine and based on the the stuff that makes the what's called the humic dent and those things when they breakdown have harmful harmful characteristics, all by themselves. So Dr task you stand by here for moment because I do want to explore with you more when we come back from a break about exactly what's in cigarette versus a regular cigarette and the effects, especially that that might have on the teenage brain. So we're talking about the fact that more cities and states are trying to raise tobacco purchasing ages to twenty one in order to curb e cigarette use amongst teams. We'll be right back. This is on point. On point is supported by legalzoom who want you to know that if you wanna make twenty nineteen the year, you finally start a business or secure your family's future. Legalzoom can help with their network of independent attorneys. Licensed in all fifty states legalzoom can help you navigate your legal needs from wills and trusts to LLC's trademarks contract, reviews and more. And the best part is legalzoom is not a law firm. So they don't charge by the hour. More at legalzoom dot com slash point. Hey, it's a fear. Is Berg host of NPR's asking me another and this month, we're celebrating women in comedy and this week from the Netflix series Russian doll. We're joined by co creator, Leslie Hedlund and actor grittily. We challenged them to not one, but two games about real nesting dolls and fashionable food trends, listen and subscribe now. This is on point Meghna, Chuck rubarski. We are talking this hour about the increasing number of cities and states who are raising their tobacco purchasing age to twenty one impart to curb the rate of teen vaping in those cities and states one know what you think about teens and e cigarettes, and whether or not you experiencing that in your own life. If you have a teen who vapes. Or if you do it yourself, and if you think raising the tobacco purchasing age to twenty one is going to make a difference in the rising number of teens who were trying out e cigarettes, and let's listen to an ad from the FDA FDA's anti vaping campaign that launched just last fall on YouTube and other social media channels meeting teens where they are the ads depict nicotine spreading through teenagers bodies and disfiguring their faces. There's an epidemic spreading. Scientists say it can change your brain. It can release dangerous chemicals like from L to hide into your bloodstream. It can expose your lungs to a leeann which can cause irreversible damage. It's not a parasite not a virus. Not an infection. It's fading. An anti V being ad from the FDA. Well, how do these ads fall on teen ears Morgan Redford of NBC's today show spoke with a group of high school seniors last fall about why vaping appeals to them and to their classmates? You come for the coolness, but you stay for the buzz. Big thing is the fact that it's just not a cigarette. You know, we're taught from really young age about like not smoking cigarettes in the damage of cigarettes and stuff like that. That's from the NBC today show some teams teens talking to Morgan Radford, we're joined today by doctors, Suzanne tense key. She's a professor of pediatrics at Dartmouth College and former chair of the American Association of pediatrics tobacco consortium. Okay. Dr danske. I would really love for you to take a little further into exactly sort of what's in an e cigarette. And you said before the break that they're all little different. But you know, what effect does it have on teenage brains. So we're going to start narrating out with a little bit of science, and we're. Going to use the analogy of light bulbs. So your your night light is four watts. The light bulbs that are above your bathroom are sixty watts and when you're reading it's probably a hundred or hundred and fifty watts we have that same kind of array of of strengths of wattage of power with e cigarettes as well and the power, plus the nicotine concentration is where you get your nicotine delivery. So all e cigarettes are all vaping devices are not the same. So if we talk about jewel, which was mentioned earlier that's a fairly low watt device seven or eight watts, but it's very high nicotine concentration around fifty milligrams per milliliter. So it's a high nicotine delivery system with relatively low power can just see jewel itself says that one of their their vaping pods could have as much nicotine as an entire pack of cigarettes. That's correct. And and I have patients in young people who are vaping a whole pot today. And I point out. Hey, you know, that's like a whole pack of cigarettes and they're shocked. They really do. Appreciate how much nicotine they're actually getting and Julius is designed for rapid hit of nicotine to your brain. It. It's been been characterized and developed so that really mimics of a combusted tobacco cigarette. Which is what really gets the nicotine levels highest new brain. So these are the highest nicotine addiction potential, these are they hit your brain. They give you that buzz as you heard from the students from there to the NBA an NBC show. So that's what the kids are really seeing. And that's what they like. And that's what makes them feel good is that little bit of a buzz nicotine is a drug that does not make you high. You don't lose your sense of perception, it just gives it that little lift net little buzz. And so it's pleasant at what the problem with that is that it becomes a d be developed dependence, and that leads to to addiction, and you need that drug in your in your blood, and in your brain in order to feel well, and you feel really poor when you don't have that on board. And so it's this it's this vicious cycle that you need it. Otherwise, you don't feel good. For sex is the fall off also relatively quick because we you know, there's all there's always ended anecdotal stories. No that we're hearing about psalm teens who are very heavy ISA grit users like needing to have it a hit from their jewel every half an hour. Right. And again, the characteristics are different. Everyone's metabolism is a little bit different. And the way people vape is different. So so we've talked about Julia's one product. But then there's other products like the single likes kind of disposables or the rechargeable they have lower power, they have lower delivery. And so those have kind of really lower addiction potential because they don't carry that same kind of a buzz and with people who are using those modifiable ones where they can change the wattage so they can tune it down. So it's more like a like your night later. They can crank it way up. So it's like your task lighting, and that changes, the nicotine delivery and that change the characteristics of how it works in your brain. And in your body. So I can't say that any individual. I can't compare three people and say, you're gonna need more. In another one, and you're gonna need another hit in fifteen minutes or three hours because everyone is a little bit different. And that's really why this is a tough thing to tackle. Because if you told me you smoke a cigarette I have a pretty good idea of how much nicotine you're getting. But with these other devices, we need to know a lot more in order to know. How do we treat you? How do we approach you? How do we help you become a non nicotine user, and we're really stuck? Because there haven't been any studies yet. Yes, doctor says he the lemme ask you here is is nicotine regarding teens is nicotine addiction the primary concern here because jewel and other e cigarette companies would say and do say that that for adult smokers e cigarettes are a healthier option because of the lack all the other compounds and chemicals that come with smoking regular cigarettes because you know, you heard in that clip before the other thing that the teen said to NBC was I think the big thing is that it's just not a cigarette. We're taught from. Young age of not smoke cigarettes in the damage cigarettes, do and stuff like that. With the implication there that the teams are saying they don't believe that e cigarettes. Do do them any damage, and that's a big problem we're having so it took twenty to forty years for us to really figure out what harms come from combusted Abaco cigarettes. So back in the nineteen hundreds before the automatic cigarette rolling machines were created people didn't smoke cigarettes. And it was only once though as they became very mainstream and very popular that cigarettes took off and you saw this mirror of lung cancer about twenty to thirty years later that really mimicked the the the curve that you saw with people smoking additional cigarettes. And so it takes a long time for some of these harms to happen in our bodies. And yes, there are not all of the constituents that are present in cigarettes. But there's a lot of things in there that are of concern in particular. We know that there are metals that can come off the coils that's not healthy to breathe into your lungs. Our bodies were not evolved to metabolize propylene glycol or glycerin in our lungs. That's not how. How our lungs work and many of the some of the other things that are in vapes are alter fine particles, and in many of the products that they've looked at the amount of Oltra find particles that are in electronic cigarette. Vapour are the same as in combusted tobacco cigarettes. You can't see these older fine particles. You can see smoke you can see aerosol. But these are things that are that are even smaller and can cross your lung tissue directly and go into your bloodstream, and cause inflammation. And we think that the inflammation is really what's driving heart attacks and strokes. And so we may not be any better off for his heart attack and stroke standpoint by people using vape as compared to combat the tobacco cigarettes, and that would be really harmful. Okay. So Dr Danske, you can imagine we have a lot of callers. Join us Limoges bring a couple of in here. Let's go to Jim who's calling from Omaha Nebraska. Jim you're on the air. Meghna my son vapes. And he aids right in front of us. So I think he really has no concept of the fact that it's bad or that it's harmful to your health or that it's like cigarettes. Thanks, jim. Don't go away to sit get how how do you feel that? He does it right in front of you. I guess he's twenty one. He's an adult. I think he's going to do it regardless. So what we say? And so I mean does it difficult situation. Okay. Well, I mean, but you you, you know, your son pro may be better than he knows himself. I mean it in the past. What is it taken taken to change his behavior when he was doing stuff that maybe you didn't think was good for him? He's been doing it for two three years without us knowing about it. And now that he's older. I just think we don't really have the ability to change his behavior now that he's older. Okay. Well, Jim thank you so much for your call. Let's hear from as land is calling from Arlington, Massachusetts, you're on the air. Hello. Thank you so much for having me. I love your show and to show today. It's so personal my wife, and I we switched over from from cigarettes to jewel about four years ago. And it was honestly the best thing we did. Because you know, they are right. There is much less less product in jeweled and regular cigarettes, and health wise, we feel so much better. But but it's so annoying. Every time I reached for it. I mean, it is I think a little more victim cigarettes just trying to quit both. It's much harder to quit. Ju I feel like, but I think what we need to do is to make uncall-. You know what I hate about? It is not the health, but the financial, you know, drawbacks from it. We we spent about three fifty a month for Joel products. And you know, that's four thousand five thousand a year we could be going towards vacations and other stuff that normal people are supposed to do. But you know, if we got to change with the marketing young. Yeah as length. Thank you so much for your call. Okay. Dr Taskey just respond to it. As and said he he switched over from cigarettes thinking, it would be healthier. Maybe he feels better. But now he's spending four thousand dollars a year on his jewel. So how what what do we know about what it would would take to end the the nicotine addiction that comes through some of these e cigarettes? Well, first of all, let me say, congratulations. I'm so glad that you were able to get off combustive tobacco because that's a huge savor of your life already. And now the next task is going to be too. See how we can get you off of jewel and off of these vaping nicotine products. And the we don't as I said, we don't have a lot of evidence as to what's the best approach because they're such variability. And because we we don't have a lot of studies that are really driving us towards a single answer. But we do know that nicotine replacement products, which are FDA approved. They are clean products. They do not have any breakdown products from being heated to high temperature. There is no metal. There's no carcinogens. They are the safest form of nicotine that we that we know about. And so I would suggest that that using switching to a form of nicotine replacement therapy to try to wean yourself off of jewel would probably be a good approach or just try cutting back on on your jewel usage. It's going to be a process because these products do have high nicotine in them, and you are likely very fizzy physically as well as psychologically dependent on this product. So getting some good behavioral support is helpful. And there are a number of places. They quit lines will help people who are vaping. In addition the truth initiative, which is has been doing a lot of work on helping young people not take up and to quit both cigarettes and vaping products. They have an app that's called this is quitting. And they just released that a couple of months ago, specifically focusing on vaping. And in the absence of of anything else. Let's give that a try for folks who are trying to quit vaping. Dr tan skin wanted them were questioned about jewel specifically because we did we did reach out to them and asked a Representative from jewel to join us today they decline that. But they did offer. This sent us quite a lengthy statement. And it reads in part this is again from jewel, we strongly support raising the purchasing age for all tobacco products, including vapor products to twenty one and have been actively supporting legislation to do this in states across the country and at the federal level. The jewel statement goes on to say we cannot fulfill our mission to provide the world's one billion adult smokers with a true alternative to combustible cigarettes than. The number one cause of preventable death in this country. If youth use continues unabated, and then they talk again about how they support tobacco Twenty-one laws so about that those adult smokers there, I mean, this even from within the public health community. This is where some of the pushback comes that that they say we shouldn't be making it harder to to get access or by e cigarette products because they are helping a lot of adult smokers who may be wanna move towards towards quitting. Does raising the the the tobacco age to twenty one have an impact on that. If you've got I know nineteen or twenty year olds who may want to use e cigarettes to quit, the youth smoking that they started at younger ages. Well, we know that tobacco Twenty-one is very effective. So I think when you were talking with Dr Morita, I don't have to use the statistic, but the the number of initiative initiatives for cigarettes in Chicago decreased by thirty six percent over two thousand sixteen to two thousand seventeen this works, and what it really we're really. Works is in the fifteen to seventeen year olds if you get tobacco products in vaping products out of the high schools kids, don't initiate, the high school kids aren't hanging out with twenty one year olds. But they are hanging out with eighteen year olds an anecdotally. I have an eighteen year old son on his eighteen eighteenth birthday, his friends called and said will you buy me jewel? Thankfully, he said. No, he knows what I do. But this is this is a real problem. We do need to try to keep it out of the high schools the number of cigarettes that are purchased by nineteen eighteen nineteen twenty twenty one twenty year olds is about one percent of the total cigarettes in the United States. So it's a fraction of cigarettes that are sold to this population. If we keep it out of their out of their hands that will have a great impact on both initiation. And cessation if they can't get the products, they're not likely to use them. And with all cases, where they've been tobacco Twenty-one Twenty-one sales restriction that's been affective. So some have not included vaping. But again, if we're preventing both cigarettes and. Ups will be getting closer to keeping kids from having them. But isn't alcohol consumption, the most obvious example of why it doesn't really matter? What legal ages that if kids want to do it or sorry if teens want to do it. They're going to get their hands on it. They will. But every barrier we put in place as Dr Morita was was saying price matters. So taxation matters, a whole lot kids are very sensitive to pricing structure. So if we make it more expensive, there are less likely to use it if you make it harder for them to get it at the at a store at at a convenience store gas station, they're less likely to use it. These barriers actually make a big difference in uptake. And so every single step. We can take is going to help. And as was mentioned earlier. And I think we'll talk about next changing the advertising also matters making this not cool. We've done a great job changing the social norm around cigarettes, and we need to now change the social norm around vaping and make it not cool. So that these young people don't think that it's the next best thing because all we're doing is. Creating a new generation of people who are dependent on nicotine and teens were dependent on nicotine become adults who are dependent on nicotine, and we need to break that cycle. Well, we will we gotta take a break in a couple minutes. And when we come back from that break, we will talk about the advertising around it. But we've got some comments here coming in online. Jason Glaspie says it'll be as affective as all prohibition throughout history has been Jason implying that it will not be effective at all. Let's see what else. Do we see here? Frank. Barton says. Yes, teen smoking vaping is a problem. So is so is any smoking vaping wired tobacco products still sold at at all. And this interesting comment from Jamie Benn's ler who says does treating young adults more like children lead them to make more child is childish decisions Dr tan, what do you think about that one? I'm a pediatrician. I love kids there my population that that I I love the most. So I don't think that's true. And and really the adolescent brain is uniquely susceptible to. Nicotine addiction. So if we prevent and protect an adolescent brain from nicotine exposure until it's well in Gillette brain is well into its twenties, it's less likely to to have a lifetime addiction. So this isn't a this isn't a child thing this developmental brain structure issue. And so really protecting those brains is better and to the point of the of alcohol, we saw a lot fewer. We're seeing a lot fewer alcohol related traffic incidents. Once we raise the alcohol h twenty one that's undeniable. We'll Dr Susan tans ski professor of pediatrics at Dartmouth College damn by for just a second. We are talking about an increasing number of cities and states raising their tobacco purchasing age to twenty one in order to curb teen vaping rates. We'll be back. This is on point. Hey, it's here. And on the latest episode of how I built this. How Alice waters pioneered the farm-to-table movement and revolutionized American cuisine along the way check it out on how I built this from NPR. This is on point magnitude already. We're talking this hour about the fact that more cities and now states are raising their tobacco purchasing ages to Twenty-one impart to curb teen vaping rates and teen e cigarette smoking rates joined the sour by Dr Susan ten ski. She's a professor of pediatrics at Dartmouth College in a former chair of the American Association of pediatrics tobacco consortium Golota comments coming in online here. MD Vecchio says my friend was a smoker and used vaping to dial down his nicotine delivery until it was next to nothing, then he stopped altogether. Thus vaping helped him quit smoking. USA Celt said says why are there? No vaping advocates on well, USA Celt. We did ask jewel. They are the dominant company in this market right now to join us, and they declined but offered a statement again. I'll just read a part of it saying that they strongly support tobacco Twenty-one initiatives in states and also at the federal level. But again. Declined. However, let's go to Ed who's calling from Ithaca New York edged you're on the air. Hello, thanks for taking my call. I smoked for fifteen almost twenty years pack and a half a day. My wife is well, we both switched vaping. And it's helped my life for mendaciously. I just want to point to the Royal College of physicians who say that e cigarettes are safer alternative almost ninety eight percent to smoking combustible tobacco. And I I agree that we should do something about the age underage vaping as a problem, but the Vilnai's vaping into ban flavors. I don't think is the right way. I think as a vape ING community all the advertising, the, you know cartoon like logos. And, you know, advertising something as specifically candy flavored is a problem, and we could do more. But I think the FDA needs to do to work more with the vaping community. So that we can come up with better guidelines for how these things should be marketed rather than to just villain is the entire, Ed. Thank you so much for your call. So let me bring Ryan Kennedy into the conversation. Now Ryan joins us from Baltimore Maryland. He's a professor of public health. At Johns Hopkins, Bloomberg school of public health. His reach research focuses on tobacco control in the US and internationally including health warnings cessation support and advertising as well. So professor Ryan Kennedy. Welcome to you. Hello magna. Okay. So you just heard our caller they're saying that he thinks the vaping community overall getting a bad rap now. And that there are better ways of working with the community to take serious efforts on curbing teen e cigarette use usage rates, where do you think about that? Now, it's always been a hard pass the walk here. We are getting more and more evidence to suggest that e cigarettes or other bay vaping devices are helpful for some people to transition away from combustibles of. We want the evidence that they can transition completely not remain. What we call a dual user. So dialing down a little bit of your smoking. But still smoking several cigarettes a day as the devices have become more mature more sophisticated. They seem to be doing a better job the ability for a device like jewel to deliver nicotine to an adult smoker. Like, we heard earlier the nicotine blood cousin traction can mirror or even exceed that of a cigarette with an experience user. So we have this device that seems to hold promise. It's certainly not safe. It's not something that I'm naive nicotine user should initiate on. But we're we're really challenged in. How we mesh message very clearly to young people just the the relative danger of these devices, we had the analogy earlier of the light bulbs. The forward the sixty one it's almost like that with tobacco products as well. When we measure by constituent buy constituent there. Are different levels of risk e cigarettes, not risk-free. They're quite dangerous. And and like, Dr ten ski was saying there's probably things we just don't know about the health effects, given the longevity of the disease manifestation. Right. So so help us understand than this core question. I mean, we're looking at the raising of the tobacco purchasing Asia Twenty-one and whether or not that's affective in curbing team e cigarette usage, but we do have a generation of advertising surrounding reducing teen cigarette or tobacco use more broadly. So there's a great amount of data here that we can we can look to to figure out what works so what does work in changing team behavior, regarding smoking or tobacco. Sure. So the the what we've learned from public health is that we typically need a very comprehensive approach we need to be using all the tools that are available to us. And that includes things like restricting marketing that includes things. Like ages purchase it includes taxes. It includes things like product regulation. We we probably should require any ISA grit manufacturer to allow consumers to purchase products that have different levels of nicotine different concentrations to help those that couple that we heard that switch. But now they want to get off. How do we do that? There's probably a role in terms of how we design these products as well jewel has been a really interesting rise for us to watch in public health, and as a product there are aspects of its design that are just so appealing to young people. It's a small kids can hide them in their hand. They're easy to share. They don't make a mess. It's not like a cigarette where you have asked and things like that the kids would have to contend with. We can probably use levers to require specific design considerations to make them in to quote, one of the callers, less cool. And so but. But then you'd have to you'd have to ask jewel to change a core aspect of their product. I mean that seems to be a lot of people would see that as as government overreach. It might be or if they're being consistent with that. What they say in that they're trying to target to adults and adult that's really motivated to quit using combustibles should be motivated to try a product that is going to work not one that's gonna be, you know, indigo blue. Well, I I wanna talk more specifically. So that's the the the design itself the industrial design of a jewel pod to begin with. But I want to explore advertising a little more here. Because one of the things that people talk about is how even though companies like jewel say they are not directly advertising through social media to teens. Nevertheless, there's a lot of I guess I don't want to say celebration. But but e- cigarette usage in social media. So how does that is there a place there? To to to curb its appeal to teenagers, right? The the marketing field has expanded with the expansion of of social media. And we're now facing sort of is about how to begin to regulate some of this content in similar ways what we've witness with drills and other manufacturers is a real mastery of the use of internet sort of the the people that influence others. They're actually called internet influencers. So if you're an individual on Instagram, and you have one hundred thousand followers companies could pay you to promote their product to use their product to post pictures of your product, and what what we've seen happen. Is this incredible boom of sort of a hashtag promotion of products where influencers might be the first out of the gate to introduce their followers to a product or product features. And then users and other even young people on the internet. Will pick up and create their own hashtags. And in a sense do all the marketing for a company keying into sort of basic branding principles. Well, you're sorry. Ryan to forgive me for interrupting there, but on this point about marketing, I just want to go to a caller really quickly. John is calling from Baltimore Maryland, John, you're on the air. Do you see a lot of ads or marketing for e cigarettes or vaping? Hey, thanks for having me. Actually, he pretty much nailed it. I I really even when I was a lot younger what I was like eighteen I I have not seen a single after vaping everything that I see is my friend that that are VP next to me for stuff on social media where people are are blowing like huge clouds, and that looks impressive. And I think that makes people want to eight more. So do you think the, you know, if we if we wanna curve teenage e cigarette uses that we ought to focus on social media, or are there other places that you would look. I I mean, I think he should focus on the media people book on how cool it looks. And the other is extremely important is the eight shops that are selling them to underage people. You know, that aren't karting and just giving it to you know, for goes in there. Well, John thank you so much for your call. Dr tan ski this has come up a couple of times that it looks cool. Right. I mean, Ryan Kennedy was just saying even this the design of a jewel itself looks cool. That's exactly the same thing that people used to say about cigarette smoking, right? It was it looked cool like movie stars were doing here. So how do we how do we change that to message that maybe it might look cool, but it isn't cool to do. Sure. An an actually if you look at some of the vaping advertising that's been out. They really took some lessons directly from big tobacco's playbook, and you look back, and you can see really mirrors of old ads in the fifties. And sixties kind of coming up again with some vaping ads. And I'm surprised that the previous caller said he hasn't seen ads because I've definitely seen them. They've been on the Super Bowl. So. So there are ads that are now on television tobacco ads been banned from TV since nineteen seventy and now there are vaping out. So there are vaping ads out there. They're in magazines there in print, they are all over social media. It's difficult to tell if something is a social media social influence, or that's been paid by an industry or is this just word of mouth, and you really can't tell the difference between those. So I completely agree. It's important for us to make these less cool, and it is going to take some peer influencers to change that conversation either in the high school, or in college is just where the young people are making this less attractive. Well, I wanna play an anti-smoking. Ed anti-smoking cigarette smoking, Ed four television made by the CDC. This is from two thousand twelve and you're going to hear someone named Harry offering tips on getting ready in the morning after Terry had throat cancer, which caused her to have allergic to me and lose her teeth in her hair. And I you. I wanna to give you head getting ready in the morning loan, noon me. And me. And made the mine. Two thousand twelve anti-smoking television ad from the CDC Ryan Kennedy do ads like that work for teens. I mean that one's kind of when I guess to designed to scare you about the effects of cigarette smoking detains get that message or they're better ways to to reach them. What we've learned in public health messaging is basically what works for an adult will work for a teen. Sometimes when we get to segmented, we're really run the risk of speaking down to the audience. Teens like to consider themselves as very sophisticated. I think something like that. With Terry obvious in marketing different messages are going to appeal to different people at different times, but her series of PSA's were super powerful and very personal. And she was very brave, and I think regardless of your age, you can appreciate that. By the way, Dr tan ski actually I'm gonna take a slight tangent here because we're getting a lot of questions about second hand smoke and vaping an e cigarettes. Is that an issue? It is a, but it's difficult to measure because again, the the changes the difference in the product characteristics. There are some vapes. As as actually Ryan was just mentioning where you have a huge, actually, the guest was signals these huge plumes, and there's a tremendous amount of aerosol that comes off of them. And when you have some of those large plumes with lots of aerosol, they do deposit more kind of particulates into a space, and in in vaping competitions and in in various locations. They've tested the air quality. And vape can make the air quality harmful, and it violates the kind of public health standards for air quality. So yes, it does introduce particular into a space depending on the product it may not actually release as much nicotine as a traditional combustion tobacco cigarette. But we do know that the vape that comes off can actually trigger asthma it can trigger respiratory complaints. So so it's not benign by itself. Ryan Kennedy here someone a little earlier a census a message on Facebook. Chris Tucker says the real story the actual story is that ultra owns thirty five percent of jewel ultra is a huge company. And a believe the end of last year. They bought this thirty five percent stake in jul- for twelve point eight billion dollars in December. And just for folks who may not know of Altria, they actually also owned, for example, they have major stake in Heuser Bush and Philip Morris as well here. So how much of the story is that these these huge companies are moving into. The the cigarettes space if I could use that phrase. I think it's exactly the story. We we need to understand that every major close system e cigarette on the market today is owned by a major tobacco company JTI Altria British American Tobacco the each have either developed or purchased e cigarettes businesses and the witnessed what we're seeing in terms of the marketing strategies the positioning it's right out of their their play books from decades ago. This is this is really concerning the the stake and jewel from Altria that kind of an investment sets up jewel, very well to take their product globally, Dr Tennessee, what do you think about that? Ryan's dead on. This is this is really concerning. And there are some different laws that are present around the globe for for kind of concentration of nicotine. And so so it'll be interesting to see what happens as time goes on and how jewel and some of these other products will change the characteristics. So that they can abide by the laws in each of these countries where they probably want to expand their market share. So I'm to the point that they can change their products. They I'm sure they will change their products to change the market and get a global footprint room. Rent will Ryan Kennedy. We've got a minute left to go here. And I want to circle back to where we started about this idea of raising the purchasing age for tobacco products to twenty one. I mean, given how popular it's teams he cigarettes are increasingly becoming amongst teens. Do you think it's an effective step or just a first step? I think it's an important step. I think the the meme that the my kids shared with me this morning was why are there toilets and the drool room? I think we need to do what we can to get these products out of the schools the access to products from older kids is a known pathway if kids don't have those products, if we don't have the social norms created in those important settings for young people. We won't have people addicted to nicotine, well, Ryan Kennedy is a professor of public health. At Johns Hopkins, Bloomberg school of public health with us today from Baltimore professor, Ryan Kennedy. Thank you so much for joining us. Thank you, Dr Susan tan ski professor of pediatrics at Dartmouth College and former chair of the American Association of pediatrics tobacco consortium, Dr tan ski thank you so much. Thank you very much. Folks. You can always continue the conversation and get the point podcast at our website on point radio dot org. Also, follow us on Twitter and Facebook on point radio. Our program is produced by antebellum and Brian Hartson ski Eileen Amata Imada, Stefan Sonus Ellison poli James Ross and Alex Schroeder with help from Matt hoesch Alex Payne and Cindy Wertheim. Sydney. Sorry, Sydney, our executive producer Karen Shiffman. I'm Meghna Chuck regard. This is on point. On point is a production of W B U R, Boston and N P R. Support for on point comes from college fine using data to provide personalized college guidance admissions advisors help high school students apply to college based on their chances of getting accepted and receiving scholarship awards. More at college mine dot com and fracture, creating frame Lewis photo decor and Gibbs by printing digital photos directly on glass. A fracture is image. And mount in one available in this election of ready to display sizes. Learn more at fracture me dot com slash on point. I made a talk RA bardy coming up on the next point President Trump wants his allies, Stephen Moore and Herman Cain to join. 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Hurricane Dorian Update; Lung Illness And Vaping

On Point with Tom Ashbrook | Podcasts

48:00 min | 1 year ago

Hurricane Dorian Update; Lung Illness And Vaping

"This message comes from on point sponsor indeed. If you're hiring with indeed you can post a job in minutes set up screener questions than zero in on your short list of qualified defied candidates using an online dashboard get started at indeed dot com slash n._p._r. Podcast from n._p._r. P._r. and w._b._z. You are boston magnetron already and this is on point hundreds of otherwise healthy. Young people are suffering from serious lung injury that seems to be linked into vaping. It's heightening concerns about the ubiquity of e cigarettes especially amongst teenagers so we'll talk about that a lot a little later this hour but i today let's talk talk about hurricane dorian almost unimaginable devastation it has wrought on the bahamas and where hurricane doria is headed next and if you're anywhere endurance path we'd we'd like to know what you're seeing or have seen and experienced now. You'll remember that when dorian win over the bahamas it was a category five hurricane that time and it stalled over the bahamas for more than twenty four hours staying at a category five the images that we're seeing out of the bahamas are almost unimaginable total devastation in parts of of the islands here's bahamas prime minister hubert minutes in a news conference yesterday saying the bahamas faces quote one of the greatest national crises in our country's history and then and he said this of the twenty five individuals that were transported to new providence to has already succumbed that would take the debt the number. That's two seven again. I want to show uninformed beaming population relation that'd be can expect more dense to be record. That's the prime minister of the bahamas hubert minutes. We'll joining us now. From nassau in the bahamas is morgan chessy n._b._c. news correspondent morgan welcome to on point and tell us what have you seen that has it's been just stay wild past thirty six hours here in the bahamas is going as showed the truth devastation that it's brought to specifically the northern islands here and you just heard the prime minister you're outside the home full basalt where those victims from avocado and had been brought the military helicopter two ambulances here on across it silent and then they've been receiving much needed medical care here and following that statement by the prime minister on to add that that number will likely be going coming up in the days ahead. I'll just striking because his parents he was a physician so whenever i spoke to him he says it's an especially hard because he knows just how how much damage hurricane can bring but following that and says that in his lifetime and never seen such a powerful storm strike with such detail consecutive sustained amount of times and that's really what is set for into port kit advocate weiland where i made landfall with wind gusts recorded of more than two hundred and twenty miles an hour hours and a sustained whenever that one hundred seventy five miles an hour tornado was bringing speed through about that same amount but only for seconds or minutes any time whereas doing who's bringing these winds for hours leveling everything in the past right now. This is one of the first days that relief and rescue efforts are really beginning in earnest on both sides <hes> simply because during and let the remnants of dangerous conditions both the year that kept a a lot of people from approaching does hard at every grand bahama on avocado island and we're now seeing that agencies able to go into avocado which dude with clean drinking water to help the five or six thousand people many of which are now homeless in that area and are all six hundred grand bahama workflow is a significant concern to the right right so grand bahama. I'm seeing here at least three out of every four homes on grand bahama underwater the airport under six feet of water and avocado island island as you mentioned a couple of times morgan the aerial footage that we're seeing coming out of there. It's unrecognizable as a place of habitation and civilization totally pulverised so billions of dollars at the very least of damage here <hes> what what what additional help do does the bahamas need lead and <hes> you know cannot aid make its way in i think from a health standpoint in need absolutely every bit of help. They can get automobile fronts. This is an unprecedented stored that has done catastrophic damage to these islands to the point where they may never looked the same simply because the power power of door and then a lot of these uninhabited smaller orlands i'd have been covered by that storm surge even after during passes and never be seen again from source standpoint are of course those emergency aid isn't going in to help those longer ground <hes> but the prime minister saying that this is a process that take years to recover from especially when you hear the early reports that about half of our buildings on avocado in grand bahama are either damaged or describing <hes> you mentioned billions. I don't disagree with that number at all important to note that these agencies are just now getting in we walk the dentist is brought to a lot of these areas <hes> for days or weeks to come simply because the damage is so severe <hes> a lot of these spots lots of slow inaccessible at this point in time <hes> we do know that airstrips are being cleared off of debris but there's not much you can do whenever they have flood waters. Where's that are covering as you mentioned that airport runway freeport which is still managed. We've seen videos of the police news in the flooded so i as long as the bahamas descent struggles is and then either the heinous people are <hes> are doing well morgan chessy n._b._c. You see news correspondent joining us from nassau in the bahamas morgan. Thank you very much. Thank you magna so obviously the bahamas have weeks months even years years of recovery ahead of the island's but hurricane doreen is now moving towards the east coast of the united states it has been downgraded from that previous category category five rating but here's jacksonville florida mayor lenny curry urging residents to remain vigilant about hurricane dorian. He spoke yesterday. This is no time to rest and i think that everything's gonna be okay. This is still very serious. Storm effects that are gonna come through our coast and could affect low lying areas well joining us now is lindsay kilbride reporter quarter for w._j._c. t in jacksonville florida lindsey welcome to on point. Thank you for having me so first of all. What are you seeing there in jacksonville and bill <hes> and how is florida preparing for what might come with dorian well as you know. It's been a slow crawl this hurricane so we're all sort of just waiting at this is point <hes>. There's a lot of evacuations mandatory evacuations two big zones here in jacksonville had mandatory evacuations. I know that's the same for almost all coastal title cities in in florida and up into georgia as well <hes> so it's kind of a question of people are are actually heating those calls. I know we've had a few the big storms over the past few years. <hes> you know there were a lot of category five hurricanes in the atlantic in two thousand six two thousand seven but then it was almost a decade until matthew you in two thousand sixteen when we really saw this again and then since matthew <hes> it's just been <hes> erma maria michael now dorian <hes> so breath at least <hes> matthew and irma really impacted jacksonville and people are sort of just comparing the storm to what's it going to be most like. Is it going to be <hes> like erma. Where we saw a a lot of inland flooding we saw <hes> areas that never thought they would get flooding <hes> their houses just filling up with water and sort of like the north in west area of jacksonville. I think you mostly expected at the beach. Which is what we saw with matthew. It's looking like it's going to be closer to something like matthew because it is skirting <music> outside of florida whereas irma kind of went <hes> kind of southwest over florida so we were on the storms east side and that brought some really unique conditions nations that we're not seeing this time <hes> but you know we're. We're just kind of waiting it out. I mean we've been waiting for so long to see like is it. Coming is going to impact us. We're going to see we were still going to see that flooding. We're going to see really really high surf and it's really gonna probably impact the the more coastal beach area <hes> which is what happened during in matthew sorry to interrupt their good. I was just gonna ask you to to remind us <hes> sort of what what the impact of matthew was. If it seems like at least where you you're in florida right now might be a little more like be a little bit more like that sure i'm so with matthew it really impacted a city just south of us which is in our listening area as well which was saint augustine <hes> which so so with fat we had just entire roads just chunks of roads on the coast just missing seeing just being pummeled by the water. A lot of businesses and homes were flooded as well <hes> so we already see a lot of beach <hes> <hes> a lot of the sand is being a road really badly even just overnight even though it's not even here yet so i think people are kind of thinking more of the beach areas are going to be impacted acted i see now. I'm seeing reports here. Meteorological reports that say that the carolinas might be facing a triple threat of high winds and flooding rain and storm surges <hes> and as you said it maybe perhaps not not that bad in in in jacksonville right now but still as as the mayor said no time to to to relax. Are there evacuations going on or have there been going. They've been going on in jacksonville. Yes aso evacuations were ordered earlier this week. I believe sunday afternoon for jacksonville and then some of the other cities ordered the same <hes> on sunday and monday as as well <hes>. It's <hes> i would say that we are. We are expecting some of the same conditions <hes> you know sixty five sixty five mile per mile per hour gusts along the coasts <hes> but it's a little different story inland which is sort of like forty mile an hour gusts but sustained winds of thirty five fifty four miles per hour is what <hes> the latest i've heard from the national weather service meteorologist. That's here in jacksonville <hes> so so that's kind of what we're expecting obviously like the storm. Surge is probably expected to be half of what we saw during irma which is good news because that is really what impacted people dylan jacksonville. I mean every a lot of people's homes were destroyed. Just completely gutted. I mean it really impacted some of these low income communities in the northwest area who who never expected it and just you know like a nearby tributary completely overflowed in their homes were waist-deep. We don't think that's going to happen this time which is good news but it's still going to be a lot higher than normal normal right now. We already have <hes> some really high levels and our river. We just don't have these other conditions. Irma brought which was we had an incredible amount of rainfall. We had this big sow you know push of win that just completely drenched us so lindsey we just have about a minute left to go and he named all those storms big-name storms and i'm thinking at the same time we're uh-huh hurricane season is by no means over this year. I mean have these the the frequency of these big stores. How has it changed life in jacksonville saville. Yeah i mean there's a lot of talk about is our cities sustainable. <hes> with the you know the sea level rise with these <hes> new you storm so it's definitely something that we're they're calling local officials to take notice and take seriously well lindsey kilbride reporter for w. J. c. t. at n._p._r. Appear a member station serving northeastern florida. She's with us from jacksonville florida lindsey. Thank you so much indefinitely. Stay safe. Thank you well. When we come back. We will talk about about the mysterious vaping related illness that some doctors are saying maybe turning into an epidemic this point this message it comes from an points sponsor indeed when it comes to hiring you don't have time to waste you need help getting to your shortlist of qualified candidates fast with indeed post a job in minutes set up screener questions then zero in on qualified candidates and when you need to hire fast accelerate your results with sponsored jobs new users can try for free when you sign up at indeed dot com slash n._p._r. Podcast terms conditions and quality standards supply starting college can be overwhelming everyone from almost every background. Has that fear that they got in here by accident. That's scary. N._p._r.'s kid is here to help. Make your freshman year a little easier. Listen to n._p._r. Life kids new guide on college sports subscribe to life kit all guides for all the episodes all in one place place. This is on point magnetic roberti. We're gonna spend the rest of the hour talking about a spike in reports of vaping related illness. It's including being severe shortness of breath vomiting fever fatigue c._a._t. Scans revealing young lungs filled with cysts. Najah lls the doctor so far have reported more than two two hundred people across the country with this mysterious long illness that seems to be linked with vaping. There's been one fatality thus far in illinois and public health officials in oregon said last night. They're investigating another death. They think could have been caused by this vaping related illness now the center for disease control and prevention and the food and drug administration say say they are working tirelessly to get to the root of seemingly new respiratory disease but there's still a lot of questions about exactly what's causing it and if that means something about the safety of vaping and e cigarettes so we want to hear from you d- vape <hes> what are your questions what questions for health experts about this vaping isn't related illness join us anytime on point radio dot org or twitter and facebook at on point radio. We'll any us from chapel hill. North carolina is ilana jaspers jaspers. She is a professor of pediatrics microbiology and immunology at the university of north carolina chapel hill. She's a toxicologist and the deputy director of the u._n._c. center for environmental all medicine asthma and lung biology professor jaspers welcome to you hi how are you. I'm doing well. Thank you so much for joining us today. Also yeah also with that's from queens. New york is dr melody peraza. She's the chief of pediatric pulmonologist at new york university's winter hospital on long island dr peraza walk. Ah peres per sorry prasada. Forgive me dr prada welcome to you. Hi how are you. I'm doing very well so the first full dossier presider you've have you seen <hes> cases of this faith vaping related illness. Yes i have and i have seen cases it mid july who presented very different ways one of them presented with <hes> acute respiratory distress and <hes> had a a very rough <hes> i._c._u. Admission full life support for one week and he's doing well now and the second case is more of a chronic exposure for three months to raping and he had weight loss twenty up to twenty five pounds in three months and cough and fever and nigel's in the long okay and so how is it that it seems as if we hadn't heard of cluster of cases before now is there's something about vaping recently that has suddenly made all these pop up about what that is a million dollar question why now how but <hes> it is for my experience with those two patients of dave are vaping t._h._c. which were take <hes> dave using not the the the regulator to product but from the dispensary is but <hes> the ones we try made maybe someone spaceman aw garage so they are homemade products and i believe that now that it is becoming becoming more and more popular among teenagers <hes> they choose a product which can be faked and cheaper and that might be the problem. I see now we eat. We dare not regulate okay so we did reach out to jewel in one of the biggest e cigarette manufacturers to see if they join us they declined but they sent us a statement that includes <hes> quote weak men c._d._c. for its investigation and we will continue individuals monitor all reports we have no higher priority than product safety which is why we have implemented industry-leading quality controls and then there statement goes on to say <hes> that reporting also suggests that many patients were vaping t._h._c. regardless those reports reaffirm the need to keep all tobacco nicotine products out out of the hands of youth and jewel underscores that they do not sell t._h._c. in their jewel cartridges but professor jaspers. There's a are you surprised by the sudden reports of vaping related illness. I'm not exactly sure that all of this is just something that has been happening since july. I'm and maybe dr. Prasada can sort of comment on that. When i've been <hes> we've been i'm doing good related research for a couple years now and it's been giving talks at different institutions and i usually ask the audience or physicians or healthcare providers within the audience <hes>. Have you seen anybody that has come in that presented with cough or symptoms that are sort of very broadly describing respiratory related illnesses <hes> and very often. I've heard from healthcare providers. These are respiratory therapists or pulmonologist and they've <hes> you know what i've seen something like that <hes> they sort of reported they thing <hes> but i didn't really should have you know pay much attention to this on so i think these these cases they may have been more isolated over the past two three four years and more <hes> more dense in certain areas <hes> since june july but i think some of these cases have been here before and it's just now there's increased awareness to make the link between vaping <hes> andy's acute respiratory <hes> lung injury. I see the actually that leads me to what was going to be my next question in which is a cd f._d._a. C._d._c. lead investigation going on right now. But can we say for certain that we're calling it vaping related but can we you say for certain at all. The vaping is what's causing these illnesses. I think that's part of the investigation at c._d._c. is doing right now. One of the problems <hes> <hes> that is on the c._d._c.'s facing is when you look at 'electronic health records which is one of the ways you could actually do a systematic analysis of love whether they were vaping <hes> whether these injuries are vaping belated not he's like twenty calls records have very poor documentation an off vaping and vaping history <hes> dr prasada can probably comment a lot better on this than i do <hes> when you look at sort of what physicians and healthcare providers the options they have in terms of documenting vaping history up until very recent. There's very little little these <hes> you know in in in addition to <hes> doctor's notes which have to be handwritten notes. There's not really a good dropdown menu. There's no icy the nine or ten code <hes> that would give doctors option. Yes this is vaping related. It's not really classified in any kind of electronic health records. I see so dr prasada. Would you like to comment on yes. Yes that's a very good point. As a matter of fact we use one of the <hes> <hes> rally establish a electronic health record system called a pitch at n._y._u. Winthrop and and what is happening is <hes>. There is a smoke cessation very <hes> strong. You know you have to make sure that you ask after a certain age to all our patients have smoking history etc but there was no waiting history as a matter of fact i was going to that's one of my my <hes> goal that i'm going to talk to the people and try to put that in that's an extremely good point <hes> yes. It needs nice to be integrated to electronic health record size now. I'm looking at a joint statement here from the f._d._a. And the c._d._c. and it says it's quite lengthy but a part part of it says more information is needed to better understand whether there's a relationship between any specific products or substances and the reported illnesses at this time there does not appear to be one product involved in all the cases although t._h._c. and cabinet wade's use has been reported in many cases so i mean dr preside. I suppose there's a lot of people listening right now. Who might just want to know. Should i be vaping or not. Should i just not use products. Teach i mean what would you advise. People okay so i'm a pediatric pulmonologist. I'm a clinician and we know that anything you inhale which has chemicals in it is not good for foia so initially in two thousand seven when these e cigarettes were created they were <hes> teetered was people who are doing traditional channel smoking and would like to quit because as you know nicotine is an addictive substance and they would gradually convert convert into eastgate and then gradually enough even the e cigarette but recently this practice has been changed and now all the your youngsters you even the middle school and high schoolers are thinking maybe that this is a cool thing and even they do not have nicotine addiction day start to rape so if you are not you haven't started vaping i would become and very very strongly not to start and if you do if you have started raping and you are doing vaping i would definitely go with the regulated product as far as t._h._c. an e cigarette and and even try to come off because now there's more and more evidence that is <hes> suggesting all these chemicals can have even long-term effect <hes> okay professor jaspers. What's your thought on that. Yeah yeah i i i take a more <hes> potentially radical approach to this <hes> i i do think that <hes> isa roots while they were or originally designed and invented to for smoking cessation. I think from the get go they were marketed and there's tributed to really also so attract. <hes> you know young adults when you look at the original sort of advertisement that was going on in two thousand eight two thousand nine with you know it was basically taking a page out of the tobacco industry playbook you know having this sort of sex appeal very you know very young hip kind of people people doing this. You are attracting not your sixty five year old c._o._p._d. Two packs a day smoker. You're actually attracting potentially new new and young adults so i think from the get-go it was the market <hes> or or the market that they tried to explore and land was including young adults <hes> now one of the things that that's really on really urgent now. Is you have a lot of these fourteen fifteen sixteen year old kids who because they were attracted to jewel and other pod based systems and the e cig industry now addicted to nicotine eighteen and what do we do with these kids now. <hes> there's really nothing <hes> not much that that we can do for them in terms of really tweeting pharmacologically treating nicotine addiction and attendance and that's something that's really urgently urgently-needed because we now have a generation <hes> on that is really sad on we now have generation that is nicotine addiction that would normally not have tried nicotine and professor gestures if i may i mean you you're you're you're not saying the word jewel but presume you really mean jewel because they're the they're the big product here in the east cigarette market and if i can just return to a statement easement that we receive from jewel i mean they emphasize that quote regardless of the fact that <hes> that first of all that <hes> as i mentioned before that some of the patients were vaping t._h._c. and you'll goes on to say quote regardless those reports refer reaffirmed the need to keep all tobacco and nicotine products out of the hands of youth through significant actions actions and regulation on access and enforcement. We must also ensure illegal counterfeiting copycat products which may be made with unknown ingredients and under unknown own standards and those that deliver control substances that those stay out of the market so ju ju. They're saying you know they stand by their product but that it might be these counterfeit products that potentially live teach seeing them. That are the problem well. That's you know that's all good on but i don't think to be quite honest and to be very blunt. I don't think we would be in the situation that we have now had you not been invented and been on the market so yes while they are now realizing this is probably a product <hes> and i'm not going to the safety of their product or the quality control of their product. I'm not doubting that <hes> but what i am saying is. I don't think we would have twenty to twenty five or even thirty percent of high. Schoolers addicted to nicotine and using pot hot based systems had you'll never been on the market and there are a lot of sort of copycat products. Now that are mimicking jewel because jewel has been so successful successful so <hes>. That's you know i think they're they're trying to do the best they can now on but i don't think we would be in in the situation situation that we have now had you not been <hes> put on the market and twenty sixteen fifteen. Let's go to tyler who's calling from sioux city iowa tyler. You're on the air. Hi <hes> though my question was how how is it that still go ahead tyler <hes> hi <hes> yeah i was wondering why the <hes> why these injuries we're just happening now recently and in such a large amount given that they've been around for over a decade and there are many people who see improvement in lung long function who used it as a smoking cessation tool and why is it that these injuries are only isolated to the united states of america. We're not seeing them in europe europe when when baby gets popular there's well. He asked a good question. Let me turn it back to our panel here tyler. Thank you for your call. Dr presente the tyler's question russian about have there been global incidences of this or is it just located in the u._s. It seems like right now. We are seeing it more in the u._s. But <hes> maybe maybe they are not recognizing just like a professor justice comment earlier <hes> it might have been around but because people blonde not thinking they might have just thought that it is a different type of respiratory infections type or or <hes> <hes> just <hes> viral infection so <hes> yes. That's a very good question but we might be recognizing. It's more now. Let's see later to reap professor jasper. Did you a share your thoughts on that yeah so one of the big differences between the the u._s. or the products that are allowed on the u._s. Market and the products that are distributed on the european market is nicotine content <hes> on the european mark from what i understand. <hes> no product is allowed that has more than two percent by volume nicotine content. <hes> jewel is at five and a lot of the knock of jewel. Usual products are up to eight percent of nicotine so nicotine content. <hes> jewish actually has a european product which is at one point five or one point seven percent nicotine whereas the u._s. product at five percent nicotine so the products are actually slightly different and what is being used in europe is is a different product and what we have in the u._s. That could be a big difference. It's just a pure matter of juice okay well. We are talking this hour about this. Mysterious potentially vaping related illness. That's popped up in more than two hundred people in the united states prompting c._d._c. investigation into its and we're joined today by professor ilan jaspers asperger's she is professor of pediatrics microbiology and immunology at the university of north carolina chapel hill. Dr melody presider joins us as well. She's chief of pediatric pulmonologist at n._y._u. Winthrop hospital in long island new york and we want to hear from you. What are your questions about. This vaping related illness is it just commander of counterfeit products coming into the u._s. market or do you have bigger questions about e cigarettes overall. This is on point <music>. What do all of these people haven't common kamla harris. Keep food adjudge and bernie sanders. They're all running for president and they've all sat down with us on the n._p._r. N._p._r. Politics podcasts appeals gonna drive me crazy. We are going out on the trail with as many of the democratic presidential candidates as we can and bringing you in indepth interviews with them. Come along by subscribing to the n._p._r. Politics podcast this is on point. I magnin <unk>. We're talking about this. Mysterious vaping related deleted illness. That's popped up in the united states prompting c._d._c. investigation and we want to know what your questions are about it now. Jewel is the big company in the east cigarette world and you alab ceo. Kevin burns spoke to c._b._s. This morning last week about the c._d._c. Investigation and the fact that some of these severe aveer lung diseases seem to be linked to the use of e cigarettes and here's what burns said c._d._c. is leading the investigations obviously in close contact with them so are working with that. We'd like to get their charging the investigation. We'd like to get all the specifics that we can. We want to make sure we have access to the information. So if there's any issue that was driven associate with us that we get to the root cause understand that that's jewel c._e._o. Kevin burns now former f._d._a. Commissioner dr scott gottlieb spoke to c._n._b._c.'s squawk squawk box team last week to talk about these mysterious illnesses and here's what he said about his views on what he thinks is jules culpability here where they bear responsibility here because they've put these sticks in the hands of the kids and now the kids are going out and buying these illegal pods they can take steps to try to crack down on some of these kind of products themselves they prob- they can't reengineer their product to not be compatible compatible with these counterfeit products unless they file an application with f._d._a. Because what they've stuck with is the product that they ahead on the market as of august of two thousand sixteen they could be bringing a new product on the market that might be foolproof against counterfeit <hes> pas but they'd have to go through the application process and so far. They've been reluctant often to do that. That's former f._d._a. Commissioner dr scott gottlieb. Let's go to harrison who's calling from edgar town massachusetts harrison. You're on the air. Hi ah yes thank you <hes> my father has smoked cigarettes and barrow on for about forty five years he ran into some long related issues and thankfully he quit cigarettes but he still oh continue to smoke pot in effort to help save any sort of healthy as since switch to the vaping products which have t._h._c. in it is he actually better off just sticking with the plant based product as opposed to the ave product. Thank you harrison. Thanks for your question professor lawn adjusters. You have a response for harrison so oh so this is. This is an interesting question and i don't so chemically speaking. I'm not sure i know the answer to that but sort of behaviorally speaking <hes> when you when you smoke pot <hes> you have a defined start and an end for you know four years sort of pot smoking session you have joint you start lighting it up there. I don't know twelve fifteen hits per joint and then you are done with these vaping t._h._c. on devices. There's less of a the flying star in an end. When you load your t._h._c. oils or waxes into your vaping device you can get many many many more puffs then then you would get out of a single joint so the dose will probably change the number of puffs of number of hits you take from vaping t._h._c. <hes> versus actually smoking joint is going to be quite different so i'm sort of not exactly sure how to address this but this is something really to considering considering. If you're one of the things you may want to ask your father is how many hits he actually takes now versus <hes> how many hits he took when he was just smoking a joint joint and professor jaspers before we go any further. Let me share my extreme apology to you kept. I keep mispronouncing your first name for some reason. My brain is just not processing basic information properly today. Luna jaspers and i do it right that time down warriors okay well so sue so dr presided. Let me ask you a follow up question. What professor jaspers said i'm wondering about the <hes> the actual oils or the chemicals that the nicotine is suspended in in in in the pods in the cartridges are are those harmful or safe. Do we know now. They are actually quite harmful. Role in an e cigarette go tambi up to fifty sixty chemicals <hes> so it is it is actually quite hey to dangerous but if you're talking about the t._h._c. for that <hes> a person who is asking the question it is a really really important if he's going to do the vaping he needs to get it from a dispensary not go and just get get it <music> out in the street because that is what is making this very very difficult for us <hes> for our cart which form the patient that we had and we send it to the department of health and initial results came back to the scene with vitamin e. in it and any kind of oil when you start got inhaling into your lungs time potentially cho's lightweight night is which is <hes> quite a dangerous and <hes> my recommendation would be to <hes> if that's a very good point with the hits but also if he's to continue vaping it has to be a licensed dismay well if i can just jump in here and say dr presided forgive me for interrupting but but a completely take your point about buying the product from licensed dispensaries but this is where once again we run into the issue of young people right of teenagers because we have a lot of states as raising raising the age of purchase to twenty one so where they're where they're going to get it. What are they usually get this stuff and also <hes> for obvious reasons seasons dispensaries. The product is much more expensive so they would like to go for the cheaper product. Yes well. Let's go back to our callers. Let's go to marley who's calling from buffalo new york marley. You're on the air hi. I'm just calling more a <hes> like personal. Uh-huh perspective. I used to smoke a lot and then i switched over to vaping and i used to not be able to walk up a flight of stairs. Now i can run on a treadmill milford five miles without stopping and i do understand the point that <hes> your guests was making about how there is no real real start and stop like with a cigarette you light it you stop and then you know you wait till you're next cigarette or this can be continuous but even so with that. I still see an improvement in lung function. I still see an improvement in overall <hes> like there's less fatigue throughout the day <hes> and and i i i know that a lot of this conversation is focusing on the children. That's getting into the hands of the kids which i think obviously is a huge problem and does need to be more regulated but to just throw out the entire. It's like okay so there's two hundred cases that have seen across the u._s. Vaping is now being demonized in a huge huge way. My state of new york is saying that now they want to ban any further they shops from opening and even no there are cigarettes in every single store every single grocery store. I saw one at a toys r. restaurants. I saw that cigarettes are so i mean i just i. I just don't think it's necessarily i don't wanna say fair. You know can't everything with a broad brush but i do think that e cigarettes are helping some people like my marley extra. Thank you very much for your call and professor jaspers. <hes> let me turn back to you here. Is there a risk of an overreaction here so marley. Thank you so much for for that call. I think that's actually a very very good point. You're bringing up <hes> they have been a few clinical studies now looking at <hes> vaping as a cessation mm tool <hes> and i have not seen anything that convinces me that it is a really effective and long-term way of is getting people off of nicotine <hes> but you know again. We're early in the process and i i would love to be convinced otherwise professor can should've been here because 'cause we did also reach out to the vaping technology association. They're the trade group. <hes> for e liquid cigarettes etc they sent us also a lengthy statement and in fairness the beginning of it they they strongly encouraged us federal investigation to go on and be comprehensive but then they also say that quote importantly major medical groups and governments have conclusively determined that vapor products are ninety five percents safer than combustible cigarettes and and studies have shown that they are nearly twice as effective at helping adult quit smoking than traditional methods okay so i didn't mean to sort of jump in there but i'm sorry <hes> <hes> so those two statements came from the u._k. <hes> and the ninety five percents state of safer statement came from public health england <hes> which which basically used very early first generation e cigarettes and looked at the number and concentrations of known carcinogens that are in cigarettes and basic compare them to what came out of an e cigarette and e cigarette had ninety five percent less of these <hes> chemical christina jones. That's that's not a fair comparison comparison because it's a very different product. Why would you soom but the same things are coming out of an e cigarette as they are coming out of a cigarette so that statement was made ah way back in the twenty in two thousand fifteen but public health england the other study that was cited by the vaping twice as effective as cigarette or as other other conventional products that is also a clinical study that was conducted in the u._k. Where e cigarettes actually increase the number of <hes> people <hes> having successful cessation from <hes> ten percent to eighteen percent or nine point nine percent to eighteen percent. The problem in that study was that after a year the eighteen percent that had used e cigarettes or still nicotine-dependent whereas the people that use conventional therapies actually completely kicked nicotine dependence so i think we need to really carefully look at these clinical trials and look at these data. I look at these statements <hes> before you know we sort of using a broad stroke no having said that <hes> i don't want to sort of throw e cigarettes completely out as a potential cessation tool for those on like the caller from from new york <hes> for those who really used them effectively as a cessation too. I do think that they may have a place in our society to do that but it needs to be regulated in that fashion and cannot be just accessible to everyone and <hes> without having any kind of you know prescription for over matter term well and our caller. Marley from new york was also concerned about people who use e cigarettes becoming demonized by this process and did not want that to happen for sure. Let's go to daniel calling from annapolis maryland daniel. You're on the air all right. How are you doing all right which is yeah. We're with you daniel. What's your comment involved. In factor of a <hes> cigarette excuse and there is nicotine and these new pod system is twenty times paper fate <hes> typically it's suspended and vegetable glycerin and propylene glycol which can be found a lot of medicine daniel so sorry to to cut you off there but your line is really shaky and i think people might have had a tough time hearing you so let me turn to dr prada here and say that dan daniel daniel was saying that he has worked in the e cigarette in the vaping industry and he was he believes that the new pods have a much higher concentration of nicotine gene and that that is what he thinks is causing these illnesses your thoughts on that unfortunately i do not have have any comment on that because the patients i took care <hes> they did not have nicotine issue. It was all but i would imagine agean <hes> i'm going to ask professor jasper who seems to have more experience with nicotine area and get your thoughts on this because i cannot comment on okay nicotine content on a professor gestures. Go ahead yeah so so on the i e cigarettes so came on the market had about one point two to three point six percent <hes> nicotine and and the regular cigarette. It's i believe it's about weight by volume about one point. Five five and these <hes> jewel has five percent to six percent and these new sort of knock off <hes> you know systems pot systems have up to what i've seen lately eight percent. That's ridiculous. High amount of nicotine <hes> that you know should be should not be allowed. I mean it's ridiculously high and so suddenly occurs to me you know a lot of the concern <hes> public health concerns around conventional cigarettes was with those combustion in products and not only what they do to the lungs of the person's smoking the cigarette but that second hand smoke do we know of what health effects if any the vapor coming out of e cigarettes might have to as a secondhand source yeah that's that's a really interesting point and and really an open question and and and i think there were a few there's a handful of articles that have reported health effects linked to secondhand beeping exposure through certainly art should be because i mean these are aerosols that are going to be available to summer mild and they're going to be inhaled by the person next to the vapor so <hes> <hes>. It's not been investigated enough. It's a really really good question. Don't you present factly right. Most likely there is going to be a link because because there are ultra fine particles which are going to be released with the raping and if you are next to that person absolutely okay. I believe that there will be issues with that down the line but <hes> so you believe that we do. We don't yet have conclusive studies around that. It's it's an area not not yet but it is common sense that if you are weeping and there is the smoke coming out with all these <hes> chemicals emiko's in it the person who is next to you will be inhaling it to okay so. I believe that there will be issue. I want to sneak one last call in here. Camello l. is calling from baltimore maryland camille. You're on the air. We've got about thirty seconds to see if we can get your your your comment in here. Hi very briefly my nineteen year also experienced a situation where he was vaping with friends. He passed out had a sustained heart rate of one hundred and seventy beats per minute per minute in the e._r. For seven hours it was it's quite scary and the doctor said he would have gone into cardiac cardiac arrest had we not been there to catch him when he passed out and call nine one nine one one so so from a parent perspective is quite alarming and there needs to be increased education <hes> pertaining to what you're getting a lot of times. These kids don't know what they're smoking right. It's a great point. Thank you so much for calling. I hope your son's doing alright. Professor jaspers got thirty seconds left here. What do you what do you think about camille said yeah. I hear you're absolutely absolutely right on. There's been actually a study that came out where with the questionnaire and they actually questioned you know the the demographic that you're that her son is in whether <music>. I'm you know what they're vaping about. Forty percent of the kids basically answered no. I'm just vaping flavors and water <hes> your their urine analysis show that they had high <hes> ah nicotine metabolite so a lot of kids don't even know that they are vaping high nicotine products and slowly actually pretty rapidly become addicted to nicotine well. Meanwhile as i mentioned we're seeing a lot of states raising the e cigarette buying asia twenty-one and just very recently michigan michigan became the first state to ban those flavored e cigarettes so a lot of attention to this on the state and federal level professor ilana jaspers professor pediatrics microbiology and immunology at the university of north carolina chapel hill. Thank you so much for being with us. Thank you for having dr melody presider chief of pediatric pulmonologist at n._y._u. Winter possible on long island dr prada thank you you thank you meghna chucker bardy. This is on point.

nicotine professor united states jacksonville florida New york Professor jaspers bahamas university of north carolina c grand bahama boston nassau ilana jaspers irma professor of pediatrics prime minister reporter c._d._c. matthew
Common Medical Practices You Should Stop Doing & What Happens if You Have No Will

Something You Should Know

56:13 min | 7 months ago

Common Medical Practices You Should Stop Doing & What Happens if You Have No Will

"Today something you should know simple ways to make yourself more attractive then a lot of medical things we do. We shouldn't like take all the antibiotic Isis sprain take. Anti-oxidants shouldn't even treat a fever. Fever is good everything that can walk fly. Crawler swim on. The face of this planet can make fever and we do it because our immune system works better at higher temperature. So when you give anti fever medicines you only prolong and worse than illness. Has It's been shown as study again. And again plus why? It's important to exercise now more than ever and bad things happen someday. You will die so you must have a will. The truth is it only takes a few hours to do it now rather than dozens or hundreds of hours if you die without one and your friends and family have to probate court. When you're at your worst all this today on something you should know. It's interesting. How A lot of car insurance company say they have the lowest rate but for you to really determine if that's true you have to do all the work comparing and shopping around and most people don't which is probably why it's been reported that Americans are overpaying on car insurance by over twenty one billion dollars but now searching for the right deal on car. Insurance doesn't have to take hours. It just takes a few minutes with the zebra dot COM Zebra Dot. Com is the nation's leading car insurance comparison site because it's the only place you can compare quotes side-by-side from over one hundred providers. You just answer a few questions on a simple fast form and they find the best rates in coverage for you in your state and the best part is it is completely free. You can save up to six hundred and seventy dollars a year using zebra dot com if your finances are top of mind right now with the current economic climate. Make sure you check out. Zebra how much can you save on? Car and home insurance will go today and start saving at the Zebra Dot Com Slash S. Y. S. K. That'S ZEBRA DOT COM slash S. Y. S. K. Spelled T. H. E. Z. E. B. R. A. dot com slash S. Y. S. K. somethingyoushouldknow fascinating Intel. The world's top experts and practical advice. You can use in your life today. Something you should now Mike carruthers. Hi and welcome to something. You should know I've lately been getting emails from people listeners. New Listeners. People who haven't listened to the podcast before but like so many of us have a lot more time on their hands so they found podcasting and this podcast in particular so welcome great to have new listeners to the podcast first up today. We're GONNA talk about making you more attractive. Here are some things that science says will make you more appealing. Women should wear red lipstick. A women's lips are the most attractive part of her body especially when colored with Red Lipstick. According to a study at Manchester University the study revealed that men stared at Women's lips for seven full seconds when they were colored red in comparison they spent just point nine five seconds looking at her eyes and point. Eight five seconds gazing at her hair men should play hard to get a study in psychological. Science found that women found a man more attractive when she wasn't exactly sure how strongly he felt about her as opposed to when she was certain he was interested. Men should wear a t shirt with a big T on it. Researchers at Nottingham. Trent University found that when men wore white tee shirts with a large black T. printed on the front women found them twelve percent more attractive. The scientists suggested that the shirt creates an illusion that broadens the shoulders and slim's the waste producing a more V shaped body. That women found sexy. Men should brewed more brooding and swaggering men are much more attractive than men who are smiling according to a study from the University of British Columbia and both women and men should keep their teeth looking good or get them fixed. If they're not a study confirmed that a white and evenly spaced set of teeth makes people see more attractive. They're assign of good health and good genetics. And that is something you should know. The Corona virus has probably gotten us more focused on and protective of our health and well-being than ever before. And it's interesting to me that so much of how we take care of our health we do because well. That's what we're supposed to do. That's what we've always heard. That's what your mom said or even. Maybe that's what your doctor told you but it turns out. There are a lot of things we do regarding our healthcare. The may not be so smart for example. If you get a fever you probably take something to bring the fever down which actually may be a really bad idea. And there's a lot more to within that Dr Paul off. It is a medical doctor and professor of Pediatrics at Children's Hospital in Philadelphia and he is author of a book called overkill when modern medicine goes too far. Hey Dr Welcome. Thank you so briefly. Explain your premise here. What are you talking about specifically those situations in modern medicine where there's abundant scientific evidence that we shouldn't be doing something but we do anyway? So for example treating fever finishing out of course Knee arthroscopy his heart stance. There's a lot of evidence that we shouldn't be doing what we're doing yet. We're still feel compelled to do it. Okay so grab one of those things you just said. Pick one and dive into the details. I think the one that would be the most surprising is that we finished antibiotic course so for example if you have asthma We treat people until they're using stops. If you have pain you treat people until their pain stops if the kidney infection and you have bacteria in your urine white cells year and you have fever and back pain once you give antibiotics per se. Several days and the fever is gone and the white blood cells in urine are gone and the bacteria gone. Why do we continue to treat and so there are now abundant studies showing that for virtually every bacterial infection? We don't need to treat as long as we have been treating and there was recently a paper in the Lancet that was titled has the Antibiotic Course had it stay and I think it has. The argument has always been that. You take the antibiotic until it's all gone because you don't want any of that bacteria to survive because then it can strengthen and become antibacterial resistant or you could get sick again that you really WanNa take it all to knock it all out. Yeah so this was born of a time when we didn't have the proper doses of antibiotics decades ago. So the point is is you're right. That's what people think. They think that if if they don't continue to treat that the either the disease will come back or that. We will create resistant bacteria. And now we're finding that in abundance studies that that's largely not true that you can stop earlier. One recent study in Spain was actually done looking at people in the intensive care unit with bacterial pneumonia. One group was treated for two for two days in which they no longer had fever. The other group was treated for ten to fourteen days. No difference in Ascom so I think you know. Now when removing two time when antibiotics or becoming progressively less available as bacteria become more and more resistant as we. We are now in a A time when at least Several patients who are being treated with bacteria phages meaning viruses that kill bacteria because these people are infected with bacteria that are resistant to all commercially. Available Innomax the time is now more than ever to save antibiotics for when we need them and certainly not to use them longer than we need them. So here's the thing that I don't understand. If these studies are readily available and every doctor in the world can see them probably should see them. Why doesn't the recommendation change? There has to be a reason why Dr would would read that here that and say but I'm GonNa do it the old way anyway. So what's that reason? Well first of all the recommendations have changed. I mean with Info so recommending bodies whether the Infectious Disease Society of America or other recommending about have changed their recommendations in line with these current studies. So your question is why. Is it that that many physicians haven't changed? I think either one because of inertia to because they don't read the studies don't read the recommendations or three sort of more subtle reason. I think they believe that they what they have been doing. Has always been good. I mean doctors are to help their patients and the notion that what they've been doing hasn't been necessary has been not. He's a little bit so it's hard to to make change but you know it's hard to to To learn new tricks. Yeah but but isn't continuing to take an antibiotic and saying that's what we do because it seems to work like giving a well person antibiotics and say see. You're not sick so it works happy right. Well I trained at a time when we used to treat bacterial meningitis until the patients. A spinal fluid essentially was largely clear of of white cells. I mean that was a ridiculous idea and we found out that we didn't need to treat nearly that long and so you know we learn as we go. There were a number of things that I've learned during my residency in pediatrics. In the late nineteen seventies. That are no longer done so we do evolve. I think we should always question our assumptions. But it's a matter of supporting The statements that I'm making this book with a wealth of Studies. It really doesn't matter what I say. The only thing that matters is what the data show and I think the data now clearly have shown that there are a number of things that we're doing in modern medicine. That don't need to be done so eventually the it's just a lag than you think. Maybe eventually things will catch up. Yes well. They're also sort of financial incentives. I mean so for example heart stance. I mean it. You know it makes sense right. I mean if you have a heart attack and you you then find that. The the one of the two major arteries that supplies the muscle is has a greater than seventy percent blockage and that the area where the heart was damages right leading to beyond that block. It wouldn't make sense to have a stent. It opens up the blockage. Sure it makes theoretical sense. The problem is it doesn't matter it doesn't matter whether you do that. You just do standard medical therapy meeting. Make sure that you exercise right then. You have a diet that you feel a high level cholesterol that that you reduce that that if you have high blood pressure that you reduce that and the reason is the reason it doesn't work. Is that the the smaller arteries that come from that. Larger artery are also blocked. And so you're not doing anything for them so the way that study was done. It was the definitive study. Was they put in stance in half the patients and they pretended to put in a stent and the other half of the patients so that so that half who who pretended have said they didn't know they didn't have staff they thought they did have a stand and the people who are evaluating them thought they did have a stand so and you found that there was no difference in outcome and so now there are a number of places in the United States that don't put in heart sense that just go to medical therapy but again there was a financial incentive here so it's harder to To convince some people not to do it well I would imagine. This is always interested me that there's also patient demand what you have to do something you've got to put in a stent because because that's what you do and we is the family. We is the patient. We demand that you do that. No I think that's a perfectly valid point especially with antibiotics. You WANNA walk out with a prescription. You WanNa make sure. Something's being done but something. Doing nothing is doing something and sometimes when you do something it can have an adverse outcome that you didn't anticipate so the point is is to always follow the data always follow the studies and do what is the least invasive elise potentially destructive thing. You can do to a patient to make sure that they get better well. How many patients go to a doctor when they have a cold or some virus or something and demand an antibiotic which from my understanding will do nothing and but they demand to get that Z pack. Because because that's doing something that's exactly right and in addition Physicians are often graded by their patients and physicians will great hire if there were willing to give an antibiotic even in a situation where there's a viral infection and antibiotic will do no good and we'll only do harm. One antibiotic do have side effects too. You can create resistant bacteria by treating with antibiotics. So you're doing hard but you're right in the sense the tail wags the dog there. The doctor wants to be liked by the patient and doing what the patient wants is more likely to make them like. Well that's ridiculous. I mean that's turning the system on its head or as you said the tail wagging the dog it it it. It doesn't make for good medicine right. It makes for bad medicine and but I think I think the doctors job is to is to help the patient through this sort of dense ticket of medical information to come to the best decision. I mean you're not you know you're a doctor in a hospital doctor in a clinic. You're not a waiter in a restaurant and your job isn't to just sort of say. Look here's a list of things we have. What would you like? Your job is to help them. Make the best safest decision even if it means spending more time with the patient trying to explain why it is that maybe not doing. Maybe doing nothing in a situation. It's better than doing something. It seems that and some of the examples in the in the book Would be well. You know what harm can it do it? What if you take a baby aspirin every day and maybe it does and maybe it doesn't prevent a heart attack but it isn't going do any harm or is it just? That was one of the surprising things actually for me. I mean my pediatrician. So we don't deal with this situation much but When if you've had a heart attack or a stroke then taking baby aspirin lessens your chance of having a second heart attack or a second stroke clearly those data or clear but if you're at risk of a heart attack or stroke so for example you have high blood pressure for example you have a high level of the bad cholesterol so-called low density lipoprotein cholesterol their studies. Show that if you take an aspirin It actually a greater risk to take the aspirin and not to take it. Because what do I? What is the aspirin doing? The what the aspirins doing is making it less likely for your blood to clot and so that you wouldn't have the stroke you wouldn't have the heart attack but that puts you at increased risk of bleeding including severe bleeding. Say You know between Your skull and your brain and other other places were bleeding can be dangerous and potentially fatal and though so studies are clear. Study after I so now. The recommendation is not to give baby aspirin to people who are at risk of stroke or heart attack but haven't had one yet yet. Still many people still do that. Even though that's not the recommendation by formal recommending bodies. It's hard to watch. Actually people continue to hold onto these outdated modes of therapy when they've clearly been shown to be harmful well but one of the one of the arguments that. I think people have or one of the reasons that they would say for example. Continue to do that is that new studies are always coming down the road that contradict the last one and so maybe it does maybe a dozen Because the data does change you know. I think that's a great point. I mean certainly I wouldn't be influenced by single study because you're right. I want somebody puts out something especially if it seems counter to everything we've been doing. You WanNa make sure that the other research groups continue to show the same thing in different areas you in different countries you know looking at different populations of people. So I think I guess I think science stands on two pillars. The first pillar is pure review. You know so you want to see that. The study has been published in a good journal. But that's the weaker of the two. The stronger of the two is reproducibility. I think we if you have a hypothesis. And you're right in this case let's say heart stance don't prolong lives or don't even lessen the degree of heart pain I angela. Then make sure that that studies repeated again and again and again and then I think you can feel comfortable. That a truth has emerged because truths do emerge. I mean sometimes. They take weeks sometimes. Years sometimes decades but truths do emerge. There are truths and I think what I try and go through in this book is is is those situations where I think a truth has clearly emerged yet still. We often ignore that truth. So what's your recommendation? When a patient goes to a doctor and he says well you might be at risk for heart attacks. So I want you to take a baby aspirin. You just tell them no. I'm not I'm not gonNA write you say. Look here baby. Aspirin LIKE ANYTHING. That has a positive effect can have a negative effect. Here's what the negative effect is. Here's the instance of bleeding. Here's the instances severe bleeding as compared to the the chance that you would or would not have a future a heart attack or stroke here here. The numbers here that you are much better off not taking this aspirin then taking and that is the recommendation now is it's not like I'm making these things up. The data supported the recommending body supported yet still often. It's not done. Yeah well okay. So but that's a yes or no do or don't as opposed to take all year antibiotics rather than you decide. Well the symptoms are gone. I'm going to stop now right. So so that's that's a good question. I mean how how to do that and I think that that. Now we're finding that that as people for example or better. They're they're feeling better if they you know they're they're they're appendicitis. Now is is is when we take less less severe example that they're they're bladder infection there cystitis now they no longer have pay no no longer have a fever? They noted no longer have white cells or bacteria in their urine. You can stop and I think that with pneumonia for example even bacterial pneumonia even severe bacterial pneumonia. If you have to a federal days two days without fever you can stop. And I think that when you're when you're immune system it's your immune system that causes the fever when your immune system bates with your immune system is saying to you we're done. We've treated this infection so believe it and then stop taking antibiotics because at that point. Bacterial replication is not an important part of that infection anymore. So stop when do you stop? Because you're starting to feel better or you stop because every last symptom is gone right and so so again and of the. Maybe ten infections that I go through in this book I go through each of those in terms of what the criteria are for stopping and and what the recommending bodies now are arguing for but but for the most part is when you start to turn the corner when you're starting to feel better because what that's telling you your immune system is is is abating and therefore Your immune system is telling you. We think we think we're done here. I'm speaking with Dr Paul off it. He's an MD and professor of pediatrics at Children's Hospital in Philadelphia and he is author of the book overkill. When modern medicine goes too far here Napa we salute the frontliners. Going the extra mile to get us through these uncertain times. You remind us of what really keeps this country moving forward and it's not just parts and tools it's people ended NAPA. Our people are proud to be part of your community so if your vehicle experiences a bump in the road just call your locally owned NAPA auto parts auto care or visit Napa online dot com because Napa knows how to safely support our communities the Home Depot is here to help and we have many ways to help. You can download our APP or go online to find the essential products and information. You need quickly. You can order what you need online and we can have it waiting for you the store or get free delivery a most orders over forty five dollars. We also thousands of how to videos for the projects and repairs. You need to make. We're here to help the Home Depot. How doers get more done. Some exclusions apply so doctor. I know you're concerned about sunscreen. And I've always found it interesting that you know. In recent decades the word is out and lots of people use sunscreen. It seems Pretty Common. That if you go out in the sun and you go to the beach wear sunscreen and yet the incidence of skin cancer continued to rise. So something's not right. What happens with science grant is people have a false sense of security they think of the term and I think the term they probably should never be used is sun block. If you want to block yourself from the sun stay inside or where protective clothing. Because there's nothing you're going to be able to put on your skin that will block the sun's harmful rays. It'll dramatically lessen it but it won't block it and I think you know as you get higher and higher levels so called. Spf Sun Protection Factor. You have a lesser capacity than if those harmful cancer causing a UV ray ultraviolet rays to to be able to penetrate into your skin I think what happens? Is people stay outside for long periods of time you know and especially when the sun is at? Its most likely time to her. You which is between ten in the morning in two to three o'clock in the afternoon and they're thinking on good. I've got on sunblock yet. Still what we now know from study after study is that that puts you at at greater risk because it isn't a sunblock because there is still some penetration because because now you're thinking I'm good. I can sat here for hours when you know the most dangerous. Uv Radiation is occurring You're at risk so again. It's just a I go through what the recommendations are now by dermatologists in terms of how to use sunscreen and sunblock and wanted to go outside and when not to go outside. But you're right skin cancers common. What ABOUT ICING SPRAYING? You say that. That's not but everybody does that right. And it's many many with the same reason we tweet fever you you feel better so you're thinking great. That must mean. I am better but the the the reason that it hurts when you sprain. Your ankle is because Info. It's because there's information because there's increased blood flow to that area. You're doing that for a reason. It's doing it because it wants to send all the sort of Factors you know the the the the blood proteins that need to get there to help heal that's damaged cartilage or ligament But when you is the sprain and decrease blood flow to the area although the pain decreases the those critical factors that need to get to. That area aren't getting there. And therefore you prolong the period of time during which it takes for you to really recover and again study after study has shown that but we still feel compelled to ice things because we want to feel better and the same things through either. I mean you know. Fever is is something we all can do everything that everything that can walk fly crawler swim on the face of this planet can make fever and we do it because our immune system works better at a higher temperature. So when you give anti fever medicines so called anti pyrex you only prolong and worse than illness has been has been shown in study again and again and again and you see this coming up now with Kobe. Nineteen people are saying you know. Don't give which was based on really a non study. It was mostly just a hypothesis. And says like you know you don't give that you can give a sediment FM which is tylenol. Well the the real answer is don't give either. I mean let your fever do what it's trying to do which is increase your body's ability to rid yourself of that virus that don't treat fever and you know we go through many many studies here that shows that There's no reason why there's never been a study. Actually in either experimental animals or people showing the treaty treating fever in any way lessens. The duration of illness isn't there always a concern. Though that if your fever gets too high the that that in itself can cause brain damage. Something right and so. That's it right but we're GONNA WE'RE GONNA fry the brain if we if we allow the people to get to high. That's not true physiological fevers mean to fevers that you make yourself in response to infection. It is true with environmental fever. So in other words. Hyperthermia if you're an athlete or you're in the military and you're outside on a hot and humid day wearing heavy clothing not allowing yourself to sweat and therefore dissipate heat. The you then can have a fever that rises so high that causes so-called heatstroke which can cause you know can cause brain damage in Ken 'cause muscle damage at Kinko's death. You know the child who's locked in the car on a hot sunny day and the parents don't realize what they're doing and then the child suffers heatstroke and people die every year from that. But that's that's not a physiological fever. Your body isn't going to hurt you but the You know but the the the the environmental fever can unless you're infected. Obviously with viruses bacteria that infects the brain. That's different but that's not we're talking about but see. That is so amazing. Because you ask anybody I mean. My wife is a nurse at my brother-in-law's a doctor. I I bet if I went and asked them if a patient comes to you with a high fever what do you do? The answer is always to give them something to lower the fever that is so embedded in the every mother every grandmother every doctor every nurse. It seems except you seems to believe that you're right There are though recommending groups Barton Schmidt I know one person who is a physician at the University of Colorado who who is sort of guru too many and he. He actually doesn't recommend treating fever so I think that it is out there not not to do it. Because as as doctors and nurses nurse Practitioners and clinicians we we want people to feel better and when you give them an anti Perak anti fever medicine they do feel better and we confuse that to think that therefore they are better but when you look at for example you know concrete. Things like virus shedding or bacterial shedding or length of symptoms. You know and degree of symptoms. You do worse by treating fever. The the classic studying this is years. Ago was in children with chickenpox. Right so half. The children with chickenpox retreated with tunnel and the other half weren't and what you found was the time to took for those blisters to heal was much longer and the children who were treated with tylenol. So you thought you were helping. But you're hurting. And there was an example action. Their hospital recently. The boy a a teenager who had hit his hip with a soccer ball. He developed this infection of the the the vessel so called thrombophlebitis with the bacteria. Mercer Right which the bacteria that bacteria then traveled to his lungs and caused Absences in his lungs traveled to brain and caused absent in his brain. It caused a bone infection joint infection. He was bad off. We retreating with the right antibiotic but day after day. He still had this bacteria and his bloodstream. Until finally we sit sat down with the the the medical staff. We sat down with the parents and we sat down with the boy and said look. Let's stop treating your fever because he had high spiking fevers every day and they were treating it every couple hours with either. This rotating sort of Either Ibuprofen or tylenol an end to try and keep the secret and we said let's just stop. Stop treating fevers. See what happens. And and he was a brave kid he said okay. He'll he'll see what he can take and you know. He had fever for a day or so And then the bacteria in his blood stream disappeared. Did the parents were convinced. It was because of what we did and I think it probably was what we did but it might not have been but in any case. I think it was a dramatic example of. How fever can work for you. Well it makes it makes all the sense in the world that you're the the body tries to heal itself and and when you kill the fever you you're basically blocking the the defense right right. I mean when you have fever. It's because your body wants you to have fever. I mean you when when you're infected you'll make certain proteins which then travel to the center of your brain and area called the hypothalamus that now reset your body temperature your your body once have a higher temperature so you do that you shiver you shunt blood from your arms and legs to your core you get under the covers you wear warm clothing you feel cold which which is another way of saying your body wants you to feel call so that you could then be warmer When you're you're the neutrophils the way the the white blood cells that make pus there. They can travel to the site of infection better. They can ingest bacteria better. They can kill bacteria better at a higher temperature. That's been shown in the laboratory. It's been shown in people again and again and again yet. Still we choose to blunt this vital aspect there are immune system because we can. I know sometimes I remember when I was a Kid. I would get a high fever even to the point where not that. I was hallucinating. But but you know your your mind starts to play tricks on you. And and that's alarming and I wonder is that a time where maybe maybe it's getting a little too high well again. I. It's a it's a balance and so I mean if you if you know there's a question about delirium associated with fever In any case I again. I think on balance Fever is there to help us not hurt us. And we shouldn't try and cripple a vital aspect of immune system. And that's what hippocrates said the backward is you know back in four hundred BC Saul Fever as something that was curative and he was right. I would imagine that when you talk and other doctors here you you must get some pushback. Yes and what is it that they say what? What is the argument against what you're saying? Well if you take fever discussion they'll say you're just not going to get people to buy that. It's just you know it's it's it's ingrained in our culture. You'RE NOT GONNA get people to do that. And and you know it was interesting when we had that discussion with the the you know the boy's parents who suffered this massive infection with mercer. They were really attentive to that. They wanted to do something that made sense to them and they want to do and now they were. They had a child who was severely. Ill but you know they were. They were willing to do that and When it was better they were converts. I mean I think we should you know get those parents out there and let them tell their story because clearly the data or or Support the notion that treating fevers bed. But you're right. I think it's you know people just like to feel better for the same reason sprains. I think it'd be hard to convince people not to do that. Because they wanNA feel better even if it means it's GonNa take a longer time to recover but just because people don't buy won't buy into it. That's a lousy art. I mean we could be for centuries hitting people with hammers to cure headaches and now we know it doesn't work or just because people want you to hit him with a hammer doesn't mean you should. I mean it's it. That's that's a stupid argument. I agree I think a nurse is not a good argument. I think that if you're going to argue it then show and also you know. They're now population studies showing that for example people with influenza when they treat their fever. They're much more likely to go outside much more likely to infect other people and much more likely to cause people to suffer and die from that infection there was as population models have redone showing that and you could make the same argument. Africa with nineteen. I mean when people treat their fever they may feel better. Feel like okay now. They can walk outside thinking that they're better but in fact they're actually shedding more bacteria. I'm sorry in the case with over nineteen shedding more virus than they were because then from not treating there because the fever helps make a certain kind of white blood cell called cytotoxic t cell kill virus infected cells and therefore make you less likely to shed so treating people fever crippled. That part of your municipal. You feel better. You feel like you can walk outside. In fact you're probably shedding more virus. In that setting you say that supplemental antioxidants increase the risk of cancer and heart disease. Nobody believes that everybody believes if you take antioxidants that that that will help prevent cancer because gets those little things and kills them. Y- The thing is I use the same line with us you know. It's not a belief systems in evidence basis. And you don't have to believe this you have to do is look at the data. I mean religions a belief system. But this is not. It's an evidence based system and and With antioxidants is clear. Didn't use your body. has a balance strikes a balance between oxidation and antioxidants in. You need oxidation to do certain things you need oxidation to kill cancer cells. You need oxidation to kill bacteria you need. Oxidation help clean out sort of clogged arteries if you will if you shift about too far in the direction of antioxidants and you can hurt yourself. And that's been shown again and again and again in study after study. Now if you look at people who eat diet rich in fruits and vegetables I rich attacks. It's Day tend to live longer have a lesser incidence of cancer and a lesson incidence of heart disease. But that's not the same thing as taking supplemental antioxidants. I mean the way that you're meant to take antitoxins food. Not in a tablet that is you know that is manufactured by a company. I mean if you take a thousand milligrams of Vitamin C. You would have to eat. Fourteen oranges or a cantaloupes to get that level of of Vitamin C. And you're not meant to eat. Fourteen oranges cantaloupes at once. And so if you if you go too far in the direction of Anti Oxidation. You can hurt yourself. I mean there are probably five studies now showing the people who take the mega doses of vitamin D increase the risk of prostate cancer Honestly if this were regulated industry vitamin E. Would have a black box warning on it saying that this product has been shown to increase your risk of prostate cancer. But it's not a regulated industry. So people don't know that and so there tends to be all these sort of vague claims supporting their use. Well I think there's long been a belief that vitamin supplements are a good idea because I think the belief is that their insurance against a bad diet. Yeah although it's hard. It's hard not to get. The Vitamin Vitamin D is another sort of crazy that were currently. I mean there's so many foods that are supplemented that it's I mean. How many people with scurvy do you know? How many can rick. It's too you know. Certainly we need vitamins. But it's hard to avoid them even with a an inadequate diet. I wouldn't know if I had scurvy Rick. I'm not sure what this curve. Symptoms of scurvy are and. I hope to never find out so leading. Gums would be one okay and that. Don't have any bleeding gums. You're probably good. I think my gums are good. Paul off it has been my guest. He's a medical doctor. He's a professor of pediatrics. At Children's Hospital of Philadelphia and his book is called overkill when modern medicine goes too far. You'll find a link to that book at Amazon in the show notes. Thanks Dr Thank you very much bullets. They save capital. One knows. Life doesn't alert you about your credit card dot Graham Street and bright in the KHAKI SHORTS. Your Free Child of movie pleasants tomorrow so you may be charged. Want to continue or cancel. Stand clear the closing doors so oh capital ones assistant. You know looks out for charges that might surprise you and helps you fix them another way. 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Should well the euphemism is should anything happen to you but mostly that means should you die or become incapacitated particularly if it were to happen suddenly without warning in July of two and nine? Chanel Reynolds husband was tragically killed in a car crash. She and her husband were totally unprepared for that. The results of what she had to go through motivated her to write a book called what Matters Most High Chanel. Welcome hi thanks for having me. You Bet so before we get into what people really need to know for themselves share. Some of what happened to you about ten years ago. I got a phone call when I was over at a friend's house with my son and It took me a while to figure out through a number of missed messages and voicemails that my husband had been in a terrible accident and he was taken to the hospital and I didn't know where he was or how bad it was but you can tell by the of information sometimes that it was pretty serious so I got to the hospital. He was still alive but barely a week after surgery in the ER and the ICU. All the Tusk came back saying the same thing which is that his injuries were UN. Recoverable was the word that they used and so after a week of realizing that our wills were drafted but not signed and we had some insurance but not other insurance and I couldn't find the password to his phone access. Basic phone numbers ever realized that for a college educated project manager. I did not have my seen together at all and that most people also didn't chew and so when my life went sideways took me. Munson years really to kind of put the pieces back together again and I realized that We kind of suck it dying and death in this country and that there are. There are a few things that we can do in advance to make a hard time. Maybe feel a little bit softer. We can't take away all the bad things that may or may not happen but we can maybe make the cushion a little bit better to ride out the storm. Do you think it's just a case of people? Don't want to face their own mortality. So that they they kind of. It's almost like if I make a will then I'm going to die Kind of thing and and we just avoid the topic be just because it's uncomfortable. It is uncomfortable and you know there are a lot of people who talk about how we are living in denial of death and I won't say that's not true. I'd also say that you know it's been so removed from our daily lives that it's a bad thing that happens rather than a thing that's GonNa happen to everyone so the data seems to support that talking about death on actually kill you and it also seems to support that it is really the one thing we have in common so while it's or uncomfortable it's as true as gravity and oxygen is and the more were prepared for it the less awful and suck it has to be for us and everybody else around us to writing a will seems like an uncomfortable thing to do. People don't really know what it is or how to do one but the truth is it only takes a few hours to do it now rather than dozens or hundreds of hours if you die without one in your friends and family have to navigate probate court and just figure out what it is and how it works when you're at your worst and you may not have the capacity or the critical thinking skills to handle it very well. I think also people think that not only will it take a long time and that? It's very complicated. That it it takes an attorney. It's going to cost a lot of money and And so people don't do we have numbers on how many people have a will over half of US adults don't have a will and that goes the same for some of the other basic what they call a state planning documents like a living will which is also called an advanced care directive or a power of attorney document which can give somebody the ability to make decisions for you if you are not able to do it for yourself but not exactly an end of life position but say you're hospitalized for a few weeks and you're not able to pay bills and somebody needs to access your bank account or keep your phone on. I think people wonder I do. I do it myself. Do I need to get an attorney and and What do you say well? Almost every attorney. I've spoken to agrees that having something is absolutely better than having nothing if you have the resources or if you have a complicated estates which means you know you might have more than a few million dollars you might have property out of. State. Let's say you have a complicated guardianship or blended family situation. Absolutely talk to an attorney and make sure that you're covered. If you're GONNA do it you might as well do it completely improperly incorrectly however a lot of people. Their situation is pretty uncomplicated. And so a lot of the online templates work just fine for many many people. And if there are a few critical items that you wanna take care of like guardianship for your kids or pets or setting up a temporary guardian for somebody if you need to go to the hospital for a few weeks anyone your next door neighbor to take care of your kids so they can stay in the house rather than going off to live with their grandparents. In another state there are a few things you can do to cover the things that you are most concerned about. And then you can always update your wills later but it can really take a short as an hour or two. You can do it on your computer. What makes a will legally binding is signing it with two witnesses and in most states. You don't even have to have it notarized for it to be legally binding. Although it's always a good idea and what happens in you can use your example your experiences as the example. But what happens when you die and you don't have one if you die without a will. It can really really suck and a lot of the things that are confusing and awful and stressful and terrifying as because you don't know what's going to happen. Some of the states are what are it's called community property state so if you're legally married the probate process could go a little more smoothly if it's clear who your heirs are. Although I have to say that generally most people don't agree with all the decisions estate will make for you while you're alive so it could very well be that you're not gonNA agree with who gets your stuff or who the guardians are for your kids. If you don't create a will and you die what's called intestate And then the state takes over your home or your assets and even guardianship of your kids is really questionable. So things can take weeks or months or years and it's much more expensive and it's much more stressful than if you would just write down a few of your basic instructions so people can say oh. Yeah here's what. Frank wants me to do with his Abu Vinyl collection and all of his Elvis jumpsuits and and call it a wrap and when you say the state who. What does that mean? Yeah so probate is a process that goes through a legal process and there is a a judge that follows the state's rules about what happens to your assets and your stuff and usually the errors are set up ahead of time and decided based on. Who's closest to you? So if you're married if you have living parents if you have. Living children are siblings. And so there's an order of of who your heirs are an who your stuff would go to but it may not necessarily go to the people that you would want things to go to and you might be sticking somebody who may not have the capacity or the ability to Go through all your stuff say you wanted one brother rather than another brother to have elvis jumpsuits or you wanted your best friend from college to have the Elvis jumpsuits but nobody would know that and that person probably wouldn't get them because because there's no instructions left behind wrote right and so in short form list here. What are the documents in a perfect world that you should? The typical person should have an and then put it in a drawer and not have to worry about it again right well. There's three basic estate planning documents that form. What's essentially the foundation of of the instructions? The first one is your will. And that's who gets your stuff and say your money and guardianship of kids or pets. A second document is a living will also called an advanced care directive and that states. You're end of life decisions for the kind of care that you do and also don't WanNa have at the end of your life. That would be where you would say. I I don't WanNa be resuscitated or I do want. The machines turned off. The third document is a power of attorney document. And that's where you can grant someone or a couple of different people rights to be your medical power of attorney even a digital power of attorney or a financial power of Attorney. So someone can step in for you and take care of your bank accounts. Closed down your social Accounts they can make medical decisions for you on your behalf if you are not able to. There are other documents and there can be many more and many more complicated ones when it comes to trust in some states or for some people Having trust is great idea but usually those are the three main documents that cover most people. If you have children of where I guess you WanNa put that in a document. What document is that? So in your will is usually where you state guardianship of kids and or pets and you can have different levels of guardians and it's always recommended to have a backup person named so you can say that your kids will go to live with your sister. You can also have Short-term or temporary guardians listed in case. You would want to have your say grandparents have the kids for the summer so you can leave instructions about who you want to have taking care of your children or pets and then also if there's any other specifics that you'd like whereas you know you would want them to finish going to school in the same state or What kind of care you would want for them to have which would be helpful information the other two things. I'd really like to mention is you can set up temporary guardianship so for example. My parents are the Guardians. Should something happen to me before my son is an adult? They live out of state. So I actually have somebody else. Listed here is a short-term or temporary guardian who can have and take care of my son for a few weeks or a few months should my parents not be able to get here in time or if they need You know to make some accommodations so that was an important thing for me to be able to know that my son could stay in the house and then the guardianship could be smoother in that. There's a little more options for that. What happens if both parents died at the same time because I imagine a lot of people in there will put you know my wife will take care of this or my husband? We'll take care of this but if they both die in the same car accident or plane crash or whatever and that in that has happened with the then what happens when having guardianship set up for If both parents are deceased is really really important because You don't want well you don't want there to be any confusion you want your kids to know what would happen so they wouldn't be confused either and you certainly don't. WanNa have a court battle over WHO's going to get guardianship of the kids during a time when really the kids would need the most amount of love and consistency and support is as possible. So that's an extremely important reason why you have a will and for me in particular as a single widowed parent. I wanted to be really clear that my son knows that if and when well if something happens to me before he is an adult or when I die that he's going to be taken care of so our conversations actually are like he said some omelets going to happen to me if I die again. I'm like well. Connie is going to be able to have you for a week or two. But you're gonNA live with grandma and GRANDPA and they'll come move here so you can finish school in you know at Your School. And his what his response normally as is like okay. Great what are we having for dinner because because especially as a kid who knows that death can happen when he's asking? What's going to happen to me if you die? He's not looking for me to say. Don't worry sweetie I'm never going to die because it isn't true and he knows it's not true. He feels better knowing that. There's a plan for him and that he'll be taken care of if something were to happen. Yeah and that goes back to that. That thing about nobody really wants to talk about death so I imagine a lot of people say don't you know. Don't worry johnny everything will be fine. I'm not going anywhere. I'm going to be here but you might not be here. It turns out you know. Today's probably not the day that you're GonNa die but let you can't make that promise and it's important to me that my son knows he's taken care of it's true. We really are uncomfortable. Talking about death we often say if I die rather than when and so even are very casual passive language around death and dying sets it up to be something that we are excluding ourselves from his humans and I think during this time right now when the world is upside down and life has gone sideways and were were feeling this urgency and the exigency at the same time. We're not just thinking about emergency. Planning and masks. Were also thinking about. Wow what's GonNa happen if something really happens and while it's scary you know. I think we're having scary conversations about hard things but we're also starting to have more hard conversations that will bring a sense of relief afterwards right like talking about what would happen if something happens and then having a plan or some options about it makes me less anxious about the idea that something would happen. Because I don't have to run around like you know. The aliens have landed and my house is on fire looking for an emergency key or knowing. I have backup phone numbers because I've already taken care of that for the person who's listening to you who find this hard to get motivated to do something. What do you say what what can you knowing? All the things you know and all you've been through? What can you say to that person that maybe that would really help? One thing that helps me just slowly bit by bit stay on top of the stuff is is uncertainty. Sucks more for me than thinking about having a plan you know hoping for the best is nice but hoping for the best is also not a plan and so even five minutes a day of just looking online and updating your beneficiaries or making sure that somebody's written down any way doing a couple things having an emergency key outside having a backup plan you know. I'm in Seattle which is earthquake country and so a lot of emergency planning and the things that you need are kind of baked into that so if something were to happen. Let's just say what would the next twenty four hours look alike and if you know That someone can get to you or you can get to them. If you know that your pets might be taken care of so you don't come home afterwards and the dogs of eating your couch. You know just a couple of things to make the noise level. Go down when the stress or the worry or the overwhelmed goes up I find to be incredibly helpful for just having lasts less things on my to do list that are constantly kind of banging against my nervous system will. It's not a particularly fun thing to talk about. But but as your own experience illustrates it's a lot easier to take care of these things ahead of time than to have to do it after the fact after someone or you dies and as you said it's not if it's when I appreciate you spending the time with US Chanel. Chanel has some free resources on her website. That can help you get this process started. Her website is Chanel Reynolds dot com. And the name of her book is what matters most. There's a link to her website and linked to her book at Amazon in the show notes. Thanks Channel Hey thanks so much was wonderful to chat with you just from talking to people and from my own experience. I know that a lot of people who like to exercise are not exercising as much as they used to before the whole corona virus thing. Because we're supposed to stay at home and it's sometimes just easier to stay at home but it's still important to exercise and there are so many good reasons to do so first of all it's going to boost your mood. A study of eight thousand Dutch People Between Ages Sixteen and sixty five found that in general people who exercise regularly were more satisfied with their life and happier than non exercisers. It also reduces stress as well as improved your ability to cope with and respond to mentally taxing situations. Exercise also boosts your confidence a lot and it helps you sleep better. A study showed that people who worked out intensely in the evening slept better than their peers. Who didn't work out or who worked out less intensely and that is something you should know. I appreciate you spending your time listening to this podcast and I hope you'll share it with someone you know. I'm Mike carruthers. Thanks for listening to something you should know.

fever Dr Paul professor of Pediatrics aspirin cancer University of British Columbia attorney Trent University Manchester University Nottingham United States bacterial pneumonia Children's Hospital kidney infection Philadelphia viral infection bacterial meningitis
Dr. Mark Bertin - A Mindful Approach to the Coronavirus

Untangle

25:13 min | 8 months ago

Dr. Mark Bertin - A Mindful Approach to the Coronavirus

"Welcome to untangle. The podcast from me is the brain. Scenting had banned and meditation studio the Five Star. I'm Patricia Carpet. Today's episode is a little different Bora. It's an interview about how he can be a bit more mindful as we face. The kind of health scare that we're facing now with the coronavirus. Please note the interview isn't with CDC specialist or even a virus expert. So it's not about what you specifically need to do day to day to prevent or limit your breasts. There's plenty of that information available. This interview is more about how we relate to uncertainty that it presents and use our mindfulness practice to be more skillful and resilient each day Dr Mark Burton is a developmental pediatrician and an assistant professor of pediatrics. At New York Medical College he incorporates. Mindfulness practices into his work. As a pediatrician at an his frequent lectures to parents teachers and healthcare professionals. Today we talk about how we can be more skillful when we get triggered were hooked into feeling a sense of panic or anxiety about it all. We have a choice to do what we can do to stay healthy as we're hearing daily from doctors and the media and we're certainly learning how to make choices over what we can actually control. He suggests that we may WANNA notice. Where are tipping point? Is that place where we go from problem solving to panic? I really like his ideas about how we can be with. What's unsettling and what feels out of our control and while we can't stamp out all of this uncertainty we can change our relationship to these are interesting times for sure now. Here's Dr Mark Burton. Dr Mark Burton. It is so great to have you on untangled today. Thank you thank you for having me here today. Well this is an interesting topic. A little different from what we've done before untangle but a lot of people are talking about the corona virus and we thought it might be really interesting to look at. What does it mean in our mindfulness practice to be aware of a health? Scare like this but to not be fearful of it. Where is that balance between taking care of ourselves than others but not getting super crazy about it? What are your thoughts on that I think? Part of it is acknowledging the fear actually though. I'm sure we can talk about that some too I mean actual. I mean this is something on a scale most of US presumably. I've never really experienced before. And actually just coincidentally as I'm sitting here talking about this like I'm not a particular expert on physician but my community is one of the ones that is dealing with it right now so I think in many ways as a starting point when we look at it. It's just like this is the essence of mindfulness practice. You look back at where I plus came from a lot of. It is just the presumption that life can be really uncertain and changing and difficult at times and a lot of our resilience relies on how we relate to that so when it comes to our day-to-day mindfulness practice. These are the moments were practising for in essence when we are dealing less something that can be so all consuming mentally. How do we stay resilient instead our best as as well as possible so I think in in many ways this is the ground of the practice? That is such an interesting way to look at it. I'm glad you said that it's important to acknowledge that fear. And it's not just the fear but what is our relationship to that fear and how will we relating to this in general and what are some of the practices that we can do to more calmly relate to something that really feels out of our control. Yeah I think that's a great perspective of Ray words into using a lot of what we're working with as we practice. How are we going to relate to our experience? Whatever comes up and it would be totally unnatural to say. We're not going to be anxious about something like this. We're not gonNA notice that but triggering us in that. We're worried about her own health about our community about some different things I mean. I think it's part of the last few years in general. There's so many things tree-ring us some things to worry about. At times and a lot of the practice is about when we feel ourselves getting codenamed. That's the core practices when we feel ourselves getting caught up in it acknowledging at and then coming back to really our overall sense of resilience so when it comes to mindfulness we noticed the difference between clearly. There's a practical side tells us? We need to see clearly when there's something we actually have to be doing because probably that's part of managing our stress and anxiety to when we know our can define for ourselves. What physically as the right thing to do in any particular moment around the corner virus. What do we need to be doing? In terms. Of some of the things they're recommending keeping the pantries stocked or a lot of hand washing and once we define that plan though we can begin to look at just? How much of our fear anxiety is that our tendency most of us is for to just keep going anyway from that point of truly. I'm doing the best I can here in terms of like I've taken care of my family. I'm taking care of myself. And so much is uncertain and his unexpected. Anyway we can begin to notice when our mind is now off into rumination planning fear of the future and just caught it and then use our practice. That comeback is best to raise able. Because I think that has layers of connotation to it on the one hand one of the things that can easily happen in stretches of time like this is it is so easy to lose track enjoying day to day life in a completely non glaciated way. Clearly if we're going to stay on top of the more challenging things that are going on we also need to be sustaining ourselves with the things that aren't so challenging and even in the middle of a time like this. I'm having a hard time sticking just two krona fire spending part of the climate change discussions part politics. It's like in the middle of all of this. If we are only caught up in the negativity only caught up in the news cycle as its own. It's like a habit of mine. Nowadays I think is that compulsive need to just be like immersed in the next news thing. The next bit of information way beyond just keeping ourselves informed. So sometimes there's value to just recognizing like in the middle of all this right now. I'm just having a family. Neil almost make that a mindfulness practice of curves sites in addition hopefully cheer today meditation practice. Whatever it is you're doing to keep yourself Strong this is the moment in time to sort of double down on your commitment to it. What are we going to do to stay resilient as this crisis continues? That's a foundational piece of this discussion to and then looking at what does it mean to today because in spite of the fact that all of this is going on. They're still family time. They're still your hobbies. They're still these moments. We can capture. That are hopefully in a nuanced way. I'm never WANNA be suggesting supposed to pretend anything feels good. That doesn't but it's more remembering that our minds you get caught up all the negativity and anger and activity and fear and then we lose out on this aspect of one thing. That's sustaining did life. Yeah I think that's a really interesting way to look at it. It's almost this idea of being able to hold opposites. You understand that there is this situation and you define the plan and you listened to the instructions that the experts are telling you and at the same time you go on with your life without getting swept into all of the nuances and details that can really be frightful right and then the second piece of probably the second layer to it obviously a mindfulness. This isn't just about is all good or anything like that. It's realistic be capturing those moments but that's part of our lives that we might miss out otherwise and then equally so looking at like this is the reality of our experience right now and it certainly all the things we already mentioned a few mass who've been talking but it's your thing and there's our reality to F- unsettling and then on some simple level to save a Nazi do we can just continually expert. Like how am I relating to that where am I am? I getting to cut up in my reaction. My Fear My denial might compulsively shopping for experts. My family needs for months now. Three months of that all these things which are not so easy to find. I mean I think that's one of the challenges of mindfulness practice quite often one of the biggest ones that comes up a lot certainly for parents you know in my field is that clearly. There's a point through which problem solving is like a really valuable important thing to be doing and then anyone who relates to. This is certainly. There's a tipping point where it often goes off into more like rumination compulsive nece all these other things and it's not such an easy line to define sometimes but even around him this we can begin to recognize that. I've done morning to do for now. There isn't anything more I can. There's nothing I can control about the situation and problem solve to the point and you today and then you notice that part of your brain. That's trying to keep you safe by continuing problem. Solve continually remain continuing to go down that path and it can be really circular over the intense and then you come back to your practicing like got it. Thank you took care of that. And then coming back to again. What's the most skillful doing right now? In the middle of all this which is all an ongoing practice and then you're going to get caught up in it again. You can make a parallel between the cell experience in any meditation on just. So you're GonNa you do your best. You'RE GONNA get up in it when you catch yourself getting caught up in navy. Nowhere News for night. No more problem solving. I'm going to then fill in the blank. Whatever feels most skillful right now? Another thing I think that's important to touch on is always the fit my essentially that bigger concept of just staying resilient during challenging times because this is also a situation where we're also talking about our physical also sleep matters and exercise matters and eating well and trying to manage a stresses best Israel because that keeps US physically healthier on the one hand held system more resilient on the other and I think that's a big part of this whole picture. I don't WanNa Talk About Mike. Plus in isolation of that too so as I was saying. It's catching yourself. When you're caught up and going down one path and just redirecting saying what would be more valuable for me right now. Yeah especially like what you're saying around problem solving and then potentially hitting that tipping point where you're leaning more towards the rumination and worry anxiety and noticing that you aren't doing that because a lot of what this is challenging us to do as you're saying how do we relate to this situation and it's the same with any crisis right. We notice how we feel. And maybe we create a plan of action and pay attention to what we can control versus what we can't control and so I think that's really interesting to be able to notice that tipping point and maybe not go there have a choice. Have not tipping point. Be a choice point where you can say. I know this is going on. I know which habits I need to change. I know what I need to do to be my best and most healthy self during this time and then do I still need to constantly worry and become anxious about it. I agree and letting go of that where he's not so easy. And I think this does relate to parenting to underlying that sometimes you were almost eluding to the serenity prayer there of which. I'm not going to buy now at the top of my head but it's like except to control what you can change the harder part of that whole quote though I think is and give me the wisdom to know the difference and I think that's where life can get really stressful and it's true. I talk about around parenting. Where the thing that's often. Triggering are stress in that moment disting- that's often triggering compulsion to do more is. We're trying to stamp out uncertainty. So the core were working with often is how are we gonNA relate you uncertainty? How are we gonNA relate to the fact that there isn't a Yes? No answer here that there isn't something to here that there isn't any way one hundred percent sure that there is a not like take this antibiotic and this is going to go away. Yes no question like that and I think that is often. What's triggering both the underlying anxiety because there's no way to get rid of uncertainty? There just isn't in this situation in many situations in life and then looking at how am I going to relate with uncertainty itself? How am I going to recognize that? Like I think in this moment as best as I can gather logically done what needs to be done. He can be into question. There's although practice along like if you can catch yourself thinking or believing something ask yourself is it. True is thought time having valuable and true because you can start to look at that a little bit and then recognized that a lot of it is actually being hooked by uncertainty and Pamela. Shoujun has a practice talking about feeling working with the hook working with the sense of we all get hosted different times in life by different. Things are natural pattern around that hook quite often to do something react in some way to it without much awareness without much ability reflecting essence and the first step to breaking that cycle is to notice. All right I'm being triggered now on. This is scary uncertain baths real and then the word cheeses than you refrain from doing that. You'll thing you just catch yourself and recognize. I'm hooked right now and I'm GONNA catch myself. Recognized this is at. This is what it feels like to be. Hooked by whatever instance. It's an awfully big hook in a very real. Yes and then see if you can refrain long enough to say okay right now. Today that feeling of uncertainty is my reality. There's nothing else to be done about it in this moment. Which is you know a practice in and of itself the last step to her for ours practice. I think she calls it is to return is to just keep working on it. It's that we tried those hooks part of our life to feel that way often. So it's not like we're gonNA hear a little discussion. We're having right now and suddenly we're never going to get hooked again but if we want to start living differently and working with the differently we can begin to recognize that visceral sense of right there it is again and try to relate to it from they try to create enough space that to just recognize that this is what's going on today and then move on from there which is clearly way easier said than done but as I think a big part of trying to manage a situation that is so wide open and nothing that any of us individually presumably can control. Yeah Tennis Comfort with. Uncertainty is great. And I'm really glad you brought that up because I do think that that's the core of so much of what people are feeling and trying to protect themselves by having enough food and getting enough giral and clorox and doing everything that they can just in case it's fat just in case that makes us so uncertain that we wanna do every single thing that we can and that what you're saying is and then it's time to just be with the situation. Just go back to your life. Do what you can do. What makes you feel safe because most of us just want ourselves in our families to be safe and we also don't want to hide in a cave during this time so we want to find that balance between taking care of ourselves our loved ones and others and also being safe. I don't WanNA stop are thinking they're at all. I think it's important foundational among all of mindfulness practice to recognize that it's not on some of. It's not really about own wellbeing specifically. Because if you start what you just brought up as I definitely want to go next is just recognizing that the intention of all that is if we're going to influence our families for the better both emotionally and literally managed the situation well for our families if we're GONNA do. We can chew cut down on the spread of the infection community. We're going to do what we can say. Whatever needs to happen next decidedly wide. There's going to be people who are out of work. There's GonNa be a lot of stuff that we all need to be aware of and support and a lot of what we're talking about. In mindfulness practice comes down to that interconnectedness. And that like you said if we're GONNA be here for our families that starts with us. Staying settled in resilient ourselves enough that it changes how engaged with them though we can be more skillful and supportive of them and of course all of this discussion of mindfulness is meant to have a big piece of that is very purposeful. It's not being okay with everything going on. It's things settled enough to see clearly. What has to happen. That's different for all of us. But we there may be things each individually can you that does have impact around everybody else. I mean if nothing else staying aware enough to do good hand. Washing techniques is a thing that begins to influence our community to being aware of. That's infection control right there. That's the core in spite of all the panic and things people are telling us to buy do that is a basic fundamental fact to be aware of. That's a huge deal right now and then keeping in mind community level data. Some of US are fortunate enough to have the resources to buy these things. Some of us are working enough to have the resources that are proud of work for a few days. There's a little bit of padding other people don't have those other people don't have the ability by anything other. People don't have the flexibility to miss work at all and then began that doesn't mean kibble of literally fixing all that but it's important to stay aware of the larger impact of everything going on and then with breach of US individually noticing when there's an opportunity to do something scuffled to help out on a bigger scale who. I'm really glad you said that because I do think it's an opportunity to be part of our community and to recognize that everyone may have a different view or experience of what's going on so I think that's taps into our compassion and empathy muscle as well. The other thing I've been thinking about is in our mindless practice. We talk a lot about changing certain habits and patterns and we talk about it in the context of how we think about things but in this challenge that we're going through right now we really have to change some habits and I was supposed to go to conference this weekend and we got an email from everyone saying there's no handshaking no hugging that will all greet each other with a bath. How or an elbow or I'm not sure exactly around town right so it is interesting because it does challenge us to look at our everyday behaviors and see which ones we might need to ship. And so what are some of your as a doctor and the mindfulness teacher? What are some of your recommendations on habits that we can like you were mentioning hand washing? I know people wash their hands but now the recommendation is wash your hands for twenty seconds and uses certain kind of soaks. Are there some ways? We can be aware of our habits. That's an interesting question. I think as a position my understanding of this but I'm afraid to this is not my field at all. Is that but people need to is mostly. Common Sense is really when it comes down to so it is the sustained handwashing and maybe being patient with someone maybe not shaking hands as much and it's also. I think being aware of our impact on the community. I heard I don't know the reality destroy but I heard for example. Someone who has tested positive then shows to go out to a party afterwards somewhere. It's being where that being conservative about that. Probably for the best of the community instead. You have worries about ourselves to care of the community if we have. But I think you're asking me a question is a little outside my medical expertise. I don't think they're recommending really more bigger radical changes than that yet. You're aware that the things tend to spread through physical contact so doing what we can to minimize that spread. I think it's just an interesting time to not to be hysterical but to be aware of how automatic some of our behaviors are and to be mindful about which ones we need to shift a little more one of the more practical ones. I've seen which is I was about to do it. Actually is the battalion one of the recommendations. Apparently he try to touch. Your face lasts which is right. That is a really seriously hard habit to change like any habit does start with awareness. That's really practically true. That's the foundation of habit formation. Always so you can bring that. Same sense of unforced awareness like. We can't just put our life under a microscope. If that's important to you then you can start to pay attention to it and see if you can shift. That happens somewhere else. That's really the key. Point is to decide which happens. You want to change or focus on and to become more aware of that and I think you're absolutely right. I putting your hands on your face or scratching your face or for me. Those are really hard ones to change. They almost feel like it's such an automatic. Yeah it's amazing. It's like it happens almost like when someone tells you not to do it you have to do it in essence exactly glasses or scratch your nose or something which doesn't make light of it. I mean if it's really part of what needs to change than it does come down to having the self awareness of Joe Atention to it and working with it as best cam. Yeah so are there any other thoughts you have on? How our mindfulness or even our meditation practice can help us through this situation. I love a lot of what she talked about today. I think it's so important. How we relate to the news how we relate to the corona virus how we relate to our community how much self compassion may have and also compassion for others. How we change our habits in small ways that are reasonable. Are there other things that we should be thinking about now? I think we touched on most of what I WOULD. WanNa say around it. I mean so. I think it's really important to ground ourselves. And recognizing the taken care of our family. Taking care of the community still starts with the only thing we directly have an influence over which the choices we make so starts a lot with coming back to your own. Mindfulness practice and maybe really committing to it. Even more than we have Up until recent times making sure we come back to that I personally find. I think a lot of people do that when we have a very grounded. Meditation Practices Easier to come back for shorter stretches during the day. So that you notice yourself being caught up in reactive during the day and you settle a little easier so I think one level we just need to trust that if we can approaching ourselves will see what actually has to get done. Then I do think I in our Internet driven culture. A lot of things that have been going on lately have really made me feel like that teaching. I mentioned at the beginning of checking in with what you hear in saying like is it true is so important so much of the. Hanoch and fear is kind of natural in any situation that feels out of control but nowadays in particular so much of his driven by the next headline the next rumor. The next I mean everything's just presented as fact so I think that maybe the only other thing I want to emphasize a little bit is in the middle of what is actually a crisis. Trying to address Rabaul settle down. See clearly what now we're hearing is actual and what they were hearing is just the next thing to go. Viral online is quite practical level too. Yeah I'm really glad you brought that up. I want to thank you for being available for us today and for sharing your thoughts on how we can better be in relationship to the situation. We're all going through so thank you so much for making time to be with us today. Marc I really really appreciate it. You're welcome thanks so much for having me here so grateful that Dr Mark Burton was able to be on our show today. If you have questions or suggestions for guests let us know at UNTANGLE ACHIEVE MUSE DOT COM? And don't forget to check out. Muse at choose me DOT COM and get your discount using the Promo Code untangled fifteen and checkout five-star at Meditation Studio in the Teens APP store. We'll see you next week.

US Dr Mark Burton Meditation Studio CDC assistant professor of pediatr Patricia Carpet New York Medical College Five Star clorox Ray Neil Israel Tennis Wan Mike Marc Shoujun Pamela Joe Atention
Show 1149: Is Cutting Carbs More Important Than Cutting Calories?

People's Pharmacy

58:32 min | 1 year ago

Show 1149: Is Cutting Carbs More Important Than Cutting Calories?

"I'm Joe Graydon. I'm Terry Graydon. Welcome to this podcast of the people's pharmacy. You can find previous podcasts and more information on a range of health topics at people's pharmacy dot com. For years. We've heard that the secret to wake control this balancing calories in calories out. Why isn't it that simple? This is the people's pharmacy with Terry. And Joe Graydon. The dogma in nutrition science has long been that all calories are created equal. Recent research has shown however that this belief may be wrong. Dr David Ludwig lettuce study that looked carefully at the metabolic effects of carbohydrates one hundred calories of sugar and one hundred calories of almonds. Don't do the same thing to our bodies. We'll find out more about Dr Ludwig research, and how should the results affect our food choices coming up on the people's pharmacy. How a low carb diet could help with weight control. First this news. In the people's pharmacy health headlines older, people who'd like to stay sharp can take one simple step. Keep moving research from rush University Medical Center examined four hundred fifty four older individuals for as long as twenty years the volunteers took cognitive tests and had physical exams every year. They also agreed to donate their brains for examination upon their deaths. Each participant also wore an accelerometer for seven days during the study. This is a device worn like a wristwatch that measures movements including small actions such as walking from one room to another or larger actions such as a vigorous exercise routine. Some of the study subjects had dementia while the others did not the accelerometer picked up differences between these two groups those with dementia made an average of one hundred thirty thousand movements daily as counted by the excel Ramadan. That may sound like a lot. But the people who were in better cognitive shape had an average of one hundred eighty thousand movements daily people with better motor skills. Also, scored better on measures of memory and thinking those who moved more during the day were more likely to be thinking, clearly and remembering things better physical activity and motor skills accounted for eight percent of the differences in cognitive test scores for years doctors have used beta amyloid plaques and tangles in the brain as a way of identifying dementia due to Alzheimer's disease. Now, scientists at the university of southern California's say they found an independent marker that may show up much earlier in the development of dementia. One hundred sixty one people over forty five years old took part in the five year study all of them completed cognitive tests that resulted in a score of zero that's normal to three severe dementia. The scientists also. Also, analyzed Cerebrospinal fluid for markers of brain capillary permeability. In addition the volunteers submitted to contrast enhanced m are is the researchers report a strong correlation between breakdown of the blood brain barrier and poor performance on cognitive tests. Further research may refine the measure of capillary leaking as an early signal of possible dementia, whether it's possible to reverse capillary, permeability and delay or prevent the onset of dementia remains to be seen dermatologists prescribed proportionally more antibiotics than other medical specialties frequently they prescribe antibiotics to treat non-infectious conditions such as acne or resign frequent antibiotic use can lead to bacteria developing resistance. So the news from a new study in JAMA dermatology is encouraging between two thousand eight and two thousand sixteen dermatologists prescribed few. You're anti-biotics overall dropping from three to two prescriptions per hundred visits antibiotic prescriptions rose, however for surgical procedures insists of study of nineteen million patients suggests that other specialists in the US, maybe prescribing antibiotics too often the scientists reviewed antibiotic prescriptions from an insurance database and examined the diagnostic codes associated with them about three fourths of the patients covered by the study. We're adults the remaining records belonged to children nearly one fourth of the antibiotics have been prescribed for common colds or coughs and were therefore inappropriate another third might be appropriate. But also might not be because they were for problems like sore throats or sign you Seitis which frequently are caused by viral rather than bacterial infections. This is the time of year when lots of people have nagging coughs, traditional cough medicine leaves a lot to be desired. Now scientists. In Great Britain, say chocolate could be a good substitute. They conducted a randomized controlled trial comparing coating containing cough syrup to a chocolate based cough medicine. This recoup goes study included one hundred sixty three patients people getting chocolate got relief from the coughs within two days that was faster than those taking codeine the trial medicine containing chocolate compounds is sold in Great Britain under the name unique off one of the authors suggest that sucking on a piece of chocolate might be a tasty and effective way to comma cough. This isn't the first time chocolate has been studied as a cough. Suppressant? A previous study found that the OBE roaming a crucial component of chocolate is an effective cough treatment. And that's the health news from the people's pharmacy this week. Welcome to the people's pharmacy. I'm Joe Graydon. And I'm Terry Graydon. Everyone agrees that obesity is one of the world's most pressing health problems overweight contributes to type two diabetes, heart disease, joint problems, and a host of other serious medical conditions. But there is little agreement about the best strategies to control weight. Some experts emphasize cutting calories. Others insist that exercise is key. When it comes to diet. There are proponents of both low fat and low carb approaches clinical trials to test. These approaches are uncommon today. We're talking about one of the largest and best controlled clinical trials on diet and metabolism. Our guest is one of the principal. Investigators. Dr David Ludwig is co director of the new balance foundation obesity prevention center at Boston children's hospital. He's all. Also, a professor of pediatrics at Harvard Medical School and a professor of nutrition at Harvard's t h Chan school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook, always delicious, welcome back to the people's pharmacy. Dr David Ludwig, great to be with you Joan Terry. Dr Ludwig we've been talking about these issues for not just weeks months years decades about dieting and about weight loss, and it seems that this entrenched belief that all calories are created equal is really hard to change. I it's foundational and the idea that you should just eat less exercise more. And the problem is solved has just not gonna way you have conducted as part of. A team. A fascinating study believe it was published in the J. And it has created a firestorm of controversy. Not surprisingly. But the data is just really interesting exciting. I'm quite quite intriguing. Can you tell us why you did how you did it and what you discovered? Sure. Well, the notion that a a calorie is a calorie is a fact of science in physics, but humans aren't toaster ovens you? We're dynamic biological systems. So that when you increase calories or specific to obesity treatment, try to cut back on calories. The body fights back in predictable ways. You know, we get hungrier. That's an experience that most dieters have long before their weight loss goal is within sight. But even if you could ignore your hunger, which is a challenge for many people just going one day. But even if you. Could ignore your hunger for months or years. The body fights back in other ways most specifically by slowing down metabolism. And that combination of hunger and slowing metabolism is a recipe for weight gain and explains why so few people can keep the weight off over the long term success of long-term obesity treatment is really less than ten percent. But it raises the question, you know, why is the average body weight? Why is the weight that our bodies seem to want to defend going up year after year? Why does the average man today say five foot nine inches way thirty five pounds more than he would have in the nineteen fifties the nineteen sixties that is a good question. Why that's what our study is aiming to explore according to another way of thinking about it called the carbohydrate insulin model. The influx of processed carbohydrates into her diet during the low fat years nineteen seventies eighties. Nineties has raised insulin levels. Now, insulin is extremely potent hormone. I call it the miracle grow fear fat cells just not the sort of miracle. You want happening in your body. Insulin promotes fat storage, and it prevents calories from being released from fat cells. So for example, in states of excess insulin action so someone with diabetes type two diabetes put on insulin weight gain, predictably occurs and the opposite. Also happens without enough insulin. It's impossible to gain weight a child with new onset type one diabetes. That's the kind of diabetes where the body can't produce enough insulin because of an autoimmune attack these children when they first come to attend. Action might be consuming three five or seven thousand calories a day. And despite that they still lose weight put the child on the right amount of insulin and wait returns to its normal trajectory give that touch held too much insulin. And he or she will gain too much weight. So the question is could these processed carbohydrates the white bread white rice prepared breakfast, cereals, potato products, cookies crackers, low fat dressings could those foods that were actually advertised as helpful during the low fat years be raising insulin levels and driving weight gain for metabolic reasons. Not because people lack will power, but simply because their body is being programmed to store too many calories and attempts to cut back calories are doomed to failure. So that's what our study aims to examine. Well, it's really innovative research. And because there haven't been. Been that many studies that are that will controlled so please describe the methodology sure one of the big controversies about this new the this hypothesis, which frankly isn't new it's got its origins back a hundred years called the carbohydrate insulin model one of the big criticisms is that the studies that exist today. The feeding studies where you give people prepared foods under a highly controlled conditions. So you can make rigorous assessments of metabolism that these studies have mostly been negative. They don't show an advantage too, low carb or low fat, particularly, but the big issue with these studies is that they're hard to do they're expensive. And almost all the studies available today are extremely short term typically less than one week. And there are only a couple that are as long as four weeks. So what's the issue with these short-term studies? Well, we know. No that the process of adapting to a low carbohydrate diet isn't immediate fact, there's a popular name for it. It's called the Kito Fluor the Keita genyk flu when you cut back carbohydrates. It takes the body. A while to adapt to using fat in more extreme cases of low carbohydrate diets using key towns and that process is predictable. It takes two or three weeks. So we need studies of at least one month to understand how these different diets will affect our metabolism and the likelihood of maintaining weight loss over the long term. That was the purpose of our study. We didn't design it for just a few days or few weeks. The study looked at low medium and high carbohydrate diets over five months, so that's plenty of time to see what happens after the body adapts, and we used a large number of partic-. Percents one hundred sixty four which compares with typical studies that might have a dozen or so so we had enough power and jurisdiction to ask this question with precision. And fortunately, we we we we saved a large philanthropic grant much larger than a typical national institutes of health grant, which oftentimes capped at five hundred thousand dollars a year. You know, one can't do this kind of study at five hundred thousand dollars a year. Our study was twelve million dollars from philanthropy. And so here's what we did. We took our participants a hundred and sixty four after they had lost twelve percent weight loss, we cut back their calories to bring their weight down by typically twenty to twenty five pounds. So what's going to happen to them? Well, we know that they're going to be hungry. The metabolism will be slowing down their body will be fighting back against that weight loss and primed to begin to regain weight. Then. We randomly assign them to these three different times. Twenty percent forty percent or sixty percent carbohydrate. And those diets had the opposite gradient fats sixty forty and twenty percent fat. We kept protein the same twenty percent. That's the rest of the calories among all three diets. So as not to have any confounding factors. So after the weight loss we randomly assigned people to these three diets, and we did one more thing we adjusted the calories to keep their weight constant for the next five months. We know that changes of body weight will greatly affect metabolism. We wanted to factor that out. So the question we're asking is does the ratio of carbohydrate to fat in the diet affect metabolism. And specifically the number of calories were burning at the same body bodyweight. We used a technique called doubly labeled water that's stable isotopes. It's considered the gold standard for measuring metabolism. Among people who are freely moving about living their regular lives. That's the most relevant question. We want to ask. And so what we found was that metabolism. Sped up on the low carbohydrate diet by about two hundred to two hundred fifty calories a day compared to the high carbohydrate diet and that difference persisted throughout the five months of our study. Now if that difference remained over the long term, it would spontaneously lead to about a twenty pound weight advantage weight loss without any changes in how much food was being eaten if a low carb diet, also produced more tidy greater sense of fullness, less hunger. Then it could potentially lead to even greater weight loss over the long term. So these findings suggest that the. Type of calories you consume affect the number of calories. You burn and that a focus on reducing carbohydrate rather than calories may be more effective for long term weight control. You're listening to Dr David Ludwig. He's a pediatric endocrinologist and professor of nutrition at Harvard's t h Chan school of public health. Dr Ludwig is professor of pediatrics at Harvard Medical School and director of the new balance foundation obesity prevention center, his books include ending the food fight always hungry, and the cookbook always delicious, we need to take a short break when we come back. We'll find out how attitudes towards dietary fat are changing will we eventually be able to end the diet wars and come to consensus about what people should eat to stay healthy. Why do people get so emotional go crazy over dietary choices? Has the study that Dr Ludwig and his colleagues published in the B M J changed how they think about diet, especially about fat. How can we put the studies findings to use in real life and lose those extra pounds? You're listening to the people's pharmacy with Joe and Terry Graydon. The people's pharmacy podcast is sponsored in part by Kaya -biotics, K A Y A -biotics offers the first probiotics which are both certified organic and Hypo allergenic I'll probiotics are produced in Germany under laboratory conditions with high quality ingredients and under strict regulatory oversight. The three available formulas are created for very specific purposes such as strengthening the immune system, fighting eastern factions and helping with weight loss to learn more about Kaya -biotics, probiotics and the important topic of gut health you can visit their website Kaya, -biotics dot com. That's K A Y A -biotics dot com. Use the discount code people for ten dollars off your first purchase. Welcome back to the people's pharmacy. I'm Joe Graydon. And I'm Terry Graydon if he would like to purchase a CD of this show, you can call eight hundred seven three two two three three four. This is shown number one thousand one hundred forty nine that number again, eight hundred seven thirty to twenty three thirty four or you can place the order online at people's pharmacy dot com. You can also download the podcast from I tunes. The people's pharmacy is brought to you in part by Kaya -biotics probiotic products made in Germany from certified organic ingredients. That's K A Y A -biotics dot com today were tackling the diet wars, why are people so emotional about their dietary choices for decades, many dietary prohibitions were based on a some. Sion's beliefs rather than scientific evidence. Even when studies were done that showed eggs don't increase the risk for heart disease. For example, many people simply didn't believe it. It's difficult to do. Well controlled clinical trials in nutrition. So we're pleased to be discussing one of the largest and most carefully executed such studies today we're talking with Dr David Ludwig. He is co director of the new balance foundation obesity prevention center at Boston children's hospital. He's also a professor of pediatrics at Harvard Medical School and a professor of nutrition at Harvard's t h chance school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook always delicious that led wig. You have just written a an important s. Say in science, which is the leading science journal here in the United States, and it is titled the dietary fat from foe to friend. Most people think that if they want to lose weight or maintain weight, they need to be very cautious about avoiding sources of fat your recent research that you have just described to us suggest that's not the case how can people catch their attitude about dietary fat? The purpose of this review. Article in science was to put together perspective based on dialogue among friendly rivals. And so in fact, our title had a question Mark at the end dietary fat from foe to friend. So so often with these kinds of articles scientist will team up with like minded individuals to write one perspective. And then the opposite happens from the other side of the debate. And what we make of this. There's very little that can be very little progress with polarization. So our goal was to put together a collaboration that represented the whole spectrum of opinion from people who were predisposed to preferring a low carbohydrate high fat diets to the opposite people who had been advocating low fat, high carbohydrate diets and other and someone. Else who was really focused on the just the quality of the foods. And what we aim to do is decide will what do we agree on? What what do the fact show what we disagree on? And then just be explicit about that. And then craft a plan for resolving these ongoing controversies with new research. So I I think that we in this paper provide a roadmap for how we can begin to get out of the diet wars that so polarized the nutrition community, especially around obesity. Well, I guess that's what fascinates me the most because the diet wars and the diet dicta crats are so adamant that they're thinking is the only right way to think and those other guys whatever it may be there wrong. So there's a tremendous emotional content. And and that translates. To the public at large. Because when we talk about, you know, fat issues, you know, how fat may not be our foe. And might even be our friend. We get inundated by messages from people who go well, haven't you read this book or that book, and don't you know about this study? Hey, you guys are just totally wrong. And you're misleading the public. I notice that one if you're co-authors Dr Walter Willett who is a frequent guest on the people's pharmacy. Arguably one of the leading nutrition experts in the world and one of the most knowledgeable epidemiologists in the world. And he's certainly come around when it comes to the fat issue. So why do you think at such an emotional target for criticism? Well, just a complete our author list. We had Jeff full IQ who's been preeminent among the low carb Kita genyk research area and Marian Neuhausler who's for many years. Advocated the advantages of low fat, the hallmark of the heart and soul of science is controversy debate. If they were no controversy, why bother doing any research to begin with. We would have all the answers in many fields and science things. Get too personal. You know, scientists have egos, and sometimes we tend to argue in ways that promote unnecessary polarization and things, of course, get much worse when you come to social media where with whatever it is two hundred eighty characters you may come up with a beautiful quip that puts your opponent into his place you think, but it's not really it's just getting more heat, not light. So we really need to reestablish a tradition of respectful dialog in my belief the pendulum had swung much too far toward demonizing. All fat storing the eighties nineties, I think that we all agree in this paper. That was a mistake that to say that all fats were bad and all carbohydrates were. I think all of Sagres with that. So I like to see the pendulum swing in the other direction. But as to whether some people would do best on relatively low fat diets other people might do best on relatively high fat diets how do identify them what about heart disease, what about cancer? There are many unresolved controversies we haven't pedantic of diet related disease sweeping the country sweeping the world, we need to work together. Nobody has the all of the answers and to be demonizing and disrespecting opponent. I think strikes at the very fabric of the scientific process decker. Not what you said that you and your co authors, we're looking for what you could agree upon. And you've just mentioned that you all agreed that the anti-fat. Dogma during the nineties was too extreme. What else did you agree on? Will we have a table in this paper, I won't go through it specifically, but we have points of consensus, and there are seven of them. And we think that the quality of the carbohydrates and the quality of the fats are key. That's actually our first point. We agree that saturated fats, at least for the general public who are also eating a lot of carbohydrate are going to raise cardiovascular disease risk now. This is a hotly contended topic. And it's not saying that we're not saying that saturated fat is public health enemy number one. That was a mistake that was made in the seventies and eighties and justified removing saturated fat and replacing it with sugar and starch, but we're saying compared to unsaturated fats for the general public too much saturated fat will raise cardiovascular disease risk, but we leave open the possibility that if you're eating a low. Carbohydrate diet, which will necessarily have a lot of saturated fat that in that state saturated fat may not be an issue. Why would that be we don't go into this much in the paper? But the ideas that when you're not eating a lot of carbohydrate the saturated fat that you consume is rapidly burned. It's rapidly oxidized metabolize. And so it doesn't stick around long for your body to to cause problems the amount of saturated fat you eat on a low carbohydrate diet doesn't reflect how much saturated fat is in your bloodstream. Dr ludwig. I wonder how your study in B M J has changed the thinking of some of your colleagues, and even perhaps some people who have been critical of your research. It is revolutionary and I wonder if it's starting to change the thinking that not all calories are created equal. Are studying B M J is among the largest and longest and most rigorously conducted to address the specific question. But it's also just one study first of all we need replication one study can never answer all questions on on a major topic like metabolism and obesity. So the study needs to be replicated we need to see how it can be applied. These principles can be applied in a real world setting. Ours was a feeding study where we prepared all of the foods that people consumed for basically a full academic year actually made a total of one hundred and sixty thousand meals during the course of the study. But of course, people will ultimately have to be able to make their own meals and put these principles into effect in a real life setting. We're up domestic in that regard in that people were able to follow these diets, and they were made from normal everyday foods, but that needs. To be examined. And then we need more research about mechanisms. So we don't claim that this is the last word, but we do hope that this study makes a more credible case for a principle that we actually all in too many of us intuitively. No one hundred calories of sugar and one hundred calories of almonds. Don't do the same thing to our bodies right hundred calories of almonds actually are a lot more filling because presumably because of the fiber. I don't know if that's the actual reason. Well, the according to the carbohydrate, insulin model when you're eating less processed carbohydrates doesn't mean getting rid of all carbohydrates, but getting rid of these highly processed sugars and starches. Levels of the hormone, insulin drop that helps to redirect calories away from deposit, in fact cells and toward the muscle the organs in the brain to help support metabolism to help you feel more satiated more full after eating and to help you burn off those calories. Dr lead the reason, I'm assuming that you all provided prepared one hundred and sixty thousand meals during that academic year and provided them to the people in your study was that that way they were much less likely to stray from what they were supposed to be eating because nutrition studies are notoriously difficult, and one of the most difficult parts is getting people to actually eat what they're supposed to end not eat what they're not supposed to so. Does it really seem likely that what you found in your study will be translatable into real life? There two basic questions that need to be asked in nutrition. Studies one is how to foods affect the body metabolism hunger. The expression of genes how do those foods affect the body under optimal conditions when you can control everything the second question is how do we take that knowledge and develop behavioral interventions and environmental public health strategies to help people eat in a way that's going to best support their health. The problem is these two questions get conflicted. They get mixed up into studies. So obscuring the signs many, unfortunately, many of the most died studies or behavioral where you tell people. You know, you're going to eat a low fat diet, and you're going to eat a high-fat diet. Or a high protein diet? And here's some recipes meal plans will meet as a group with a dietitian three or four times over the next six months now, go out and do it. Actually, I'm going to disagree with you, Dr Ludwig, I think most of these studies are epidemiological in h and so well, some researcher says, well, what are the people in northern China eating? Yes, they're eating rice. That tells the story and somebody else does. Well, I'm going to study the people in Italy in look at the Mediterranean diet, and they're not even controlled they're just sort of. Well, we make assumptions about what they're eating and then draw conclusions which may be completely inappropriate. Yeah. Well, the certainly problems with epidemiological studies, and they can be misinterpreted. There's a range of quality that doesn't mean all epidemiological observational. Studies are are this leading many critical, and there's some questions we can never ask with a clinical trial. But there's this Doshi. In that just because it's a clinical trial means it's high quality data. And that's not the case in most dietary behavioral trials where you put people even if you randomize them on different diets the level of support the intensity of support is low. So that people don't maintain differences in their ways, they're eating, and how do we know that will you can look at biomarkers things that we'd know should change in the blood. If people are eating one way or the other and more often than not these biomarkers show, virtually no difference between the diets so out of these studies, people conclude that diet doesn't matter and it's all about compliance. But that's a false conclusion. What we have to clue from these studies as we need more intensive interventions. The think of doing a study with a new cancer drug. Let's say you came up with a potentially remarkable cure for childhood leukemia, and you put one group of kids. Assigned one group of kids to consume the strike and another group to consume a placebo. But it turns out they never took the drug maybe it was too expensive to afford. Or maybe the parents couldn't find a pharmacy that provided it or maybe there were minor side effects that could have been worked with would you conclude that the drug didn't work? No, you'd say we need a better study before we dismiss that truck. Unfortunately, that basic logical principle doesn't apply to most diet research. How did your research work did people follow it for the most part and did your biomarkers reinforce that idea? So in our study, we didn't use behavioral approach we did a feeding study where we actually produced and provided meals for all of our participants. Basically for a full academic year. It was based on a college campus framingham state university in Massachusetts. And because we were providing foods observing at least one meal a day. For most people and making it really easy for them to eat this way, we could confidently obtain much higher levels of compliance and our biomarkers. We looked at multiple ones demonstrated that very substantial and sustained discrimination between the groups which lets us know that they were actually eating very differently and that provides a basis for making more informative conclusions about how diet affects biology. The next step is to figure out are are these findings real can they be replicated? And if so how can we apply them to a real world setting? But we don't want to jump to that translation to quickly that was the mistake made in the nineteen seventies and eighties with the low fat diet. We jumped to try to get population to change their ways of eating without understanding how that new way of eating would actually affect our biology. You're listening to Dr David Ludwig. He's a pediatric endocrinologist and professor of nutrition at the Harvard t h Chan school of public health. Dr Ludwig is professor of pediatrics at Harvard Medical School and director of the new balance foundation obesity prevention center, his books include ending the food fight always hungry and always delicious unitary. This kind of study is unusual number one that they controlled for the food intake, so carefully. You know morning noon tonight, they had large number of people involved. And it was a long-term study months. Well, in fact, the fact that they prepared a hundred and sixty thousand meals for those participants during the study that's pretty impressive after the break will find out what seems to work to help. People lose weight sometimes exercise mix people super hungry. What's going on? How can you manage this affect what it makes sense to reduce easy access to processed carbohydrates through pricing or taxes? How does a low carb diet change our bio markers, and how should we interpret those changes, and which biomarkers might be most helpful in detecting and preventing diabetes and heart disease. You're listening to the people's pharmacy with Joe and Terry Graydon. If you've Allieu the health information, you get when you listen to the people's pharmacy consider subscribing to our Email newsletter. You'll get the latest health news and information on upcoming podcasts delivered to your inbox twice a week look for the link at people's pharmacy dot com. Welcome back to the people spire Masih. I'm Terry Graydon, Joe Graydon to purchase a CD of today's show or any people's pharmacy broadcast. You can call eight hundred seven three two two three three four today show is one thousand one hundred forty nine that number again, eight hundred seven three to twenty three thirty four or you can find it online at people's pharmacy dot com. You can also download the free podcast for my tunes or from our web store, and we invite you to consider writing a review that people pharmacy is brought to you in part by Kaya deke's probiotic products made in Germany from hypoallergenic organic ingredients K A Y A -biotics dot com. The diet wars have been raging for years each side has ardent proponents. Those who insist that a low fat diet is the best way to control weight and those. Those who are convinced that a low carb diet is better have had a hard time finding common ground for far too long. The nutrition arena has been dominated by such preconceived ideas, large scale surveys. Don't always provide the details. We need to understand how nutrition works at a metabolic level, the carbohydrate insulin hypothesis was recently tested in a rigorous trial conducted by our guest, we're talking with Dr David Ludwig. He is co director of the new balance foundation obesity prevention center at Boston children's hospital. He's also a professor of pediatrics at Harvard Medical School and a professor of nutrition at Harvard Chan school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook always delicious that led wig. We understand. You have some exciting future research in mind. Can you tell us a bit? About it. Sure. Well, our most recent study, which we called f s to framingham. State. Interstate study looked at what happens when you keep bodyweight the same. What happens to metabolism? And we saw that metabolism. Speeds up by about two hundred to two hundred fifty calories a day on a lower carbohydrate diet twenty percent carbohydrate. But the next question to ask is what happens when you lock calories on these different diets what happens to body, bodyweight and most importantly body fat. And that's the purpose of our next study. And in fact, we're taking to the next level of rigor in our last study, we prepared foods for people and observed meals being consumed, but they were free living and some degree of noncompliance is inevitable. So to look at changes in body weight or body fat. We've got it. Make sure that everyone is eating. Exactly the same number of calories. This is the ultimate test of whether all calories are like and so to do this. We're presently recruiting honored and twenty five people who will I lose on average about fifteen percent of their weight on a low calorie low carbohydrate diet, we'll stabilize them and then stabilized their weight and then at that new lower weight, they'll take up residency at a beautiful lakefront retreat center in the woods. Very isolated long away from any long way away from fast food chips crackers soda as we'll be able to maintain twenty four seven oversight of our participants. Giving them every Neil that they're observing every meal that they're consuming closely monitoring their metabolism and then doing eva-britt studies of their body composition in. In other relevant biological outcomes. So that studies ongoing we welcome anybody in the greater New England area to apply it's called the F B four study, and you can find us at Boston children's hospital. So this study is really our next up. But we also need other. Studies by independent groups to ask these questions into fit ways that let read the last time we talked to you. You had just published always hungry, and that book has a number of stories in it about people who have come to you for help, which you mind sharing a couple of stories about how people approach weight loss, and what seems to work, and what doesn't seem to work. Right. So we're undergoing so we're making a transition from science which is meticulously controlled two, anecdotes and. Any import? Yes, they really show us. And there's a long history of case stories case studies and medicine, but it's important to note that anecdotes are just individual experiences, and they don't necessarily apply to everybody. But with that said, I'm happy to to summarize some common stories that we've heard both in the pilot project leading up to our book. But also in our Facebook group, we have a free and noncommercial Facebook group called the official always hungry book community. We welcome your listeners to join and very frequently. We hear that when people give up processed carbohydrates phase one of our three face program brings carbohydrates down to twenty five percent. So you can still have whole fruits plenty of vegetables and other sources of carbohydrate, but in at least for two weeks. Completely eliminates the processed grains sugar potato products, very common antidote is that before people have seen any weight loss. They suddenly experience a shift in their control around food. In other words, the go to a party, and the, you know, the keys the cake the ice cream are displayed. Whereas it used to be a constant battle for them. They have to walk out of the room. So is not to be tempted somehow those foods very quickly lose lose their power over people that people are able to take a bite and say, all right. That's you know, that's nicer might they might even say, wow, that's just too sweet. I don't like it anymore. But they're now more in control. And then once that shift has happened. That's a very good sign that the the weight will will come come soon. One of the things that is sort of. We'll say semi personal as we know an individual who exercises really vigorously and sometimes at the end of that exercise experience, there's this ravenous hunger feed me feed me now or I will kill you kind of situation. I'm wondering what's happening metabolic -ly after somebody has like maybe run ten or fifteen miles, and then has this incredible hunger that requires immediate gratification. That question goes to the heart of why it is so difficult to lose weight and what our current paradigm of calories in calories out. All calories are like might be missing. We know that simply cutting back on calories shut low calorie diet should produce weight loss. But it's so hard to follow and that's not just poor willpower. People who try to lose weight are very disciplined. But somehow, they get overwhelmed with hunger and the same is true, physical activity time, and again analyses of exercise studies show that it's certainly a good thing for health might improve your cholesterol or lower some other cardiovascular disease risk factors, but exercise is a really poor way to cause weight loss in any reasonable timeframe over months even a few years, and that again has to do with the same problem that the body fights back against efforts to change wait that when you eat less. Your body says I need more calories. And when you try to burn off calories without. Changing metabolism through exercise. The same thing happens you finish the exercise. You burned off a lot of calories, but your body is screaming at you. What we need to do is figure out what is going on metabolic -ly. That's driving weight up year after year after year making the average person way twenty five to thirty five pounds more than forty years ago. If the problem is hormonal if the problem is too much insulin caused by all of the processed carbohydrates and our diet, then just cutting back calories while continuing to eat all those process carbohydrates trying to force calories out of the body with exercise is setting up a battle between mind and metabolism were doomed to lose. So it sounds as though your recommendation, essentially as a policy would be to reduce the amount of processed carbohydrates that we all have. Such easy access to. Many of the policy recommendations that would naturally flow from this way of thinking are already being incorporated in a we we we all now recognize that the de-emphasis on sugar that the the focus on just getting rid of all fats. Remember, the top of the food guide pyramid. Put all fats knots. Avocado olive oil dark chocolate some of the foods that we know are exceedingly healthy in don't promote weight gain per se. They were all put at the top and a whole host of processed carbohydrates six to eleven servings were placed at the bottom sugar was identified only as a concern for special populations specifically children at risk for getting cavities. So we all now recognize that that obsession with fat, and you know, the the past that was given processed carbohydrates was a mistake. And we need to be cutting back on sugars, processed grains too much. Potato products where are this carbohydrate, insulin model this way of thinking about obesity, would take it to the next step is that we want to bring the total amount of carbohydrates down a bit doesn't mean getting rid of all them. In fact, you can still have plenty of whole fruits vegetables, certain kinds of root vegetables. And some minimally processed, grains, the kinds of grains, that we would have consumed generations back things. Like steel cutouts, barley teff keen watt. These are slower digesting. So you can still have some of those. But we want to emphasize the healthy fats olive oil nuts nut butters full-fat. Gary. There's really no advantage of fat free milk overhaul milk and then get enough protein, and that this will be a more sustainable way for most people to maintain a healthy weight over the long term Dr. Twig in the old way of thinking fat was blamed for not just obesity, diabetes, and heart disease, and possibly even cancer that has to a larger extent been discredited. I'm wondering in your study in which for example, the low carbohydrate group who were getting twenty percent of their calories from carbohydrates sixty percent of their calories from fat and twenty percent if I'm not mistaken from protein, how did their biomarkers respond is that kind of diet the so-called low carb diet in your group? Did they have better biomarkers when it comes to things like, diabetes and heart disease? We just published the initial results of the study, and we're still in the process of examining a whole range of diabetes, and heart disease risk factors but included with that I study where. HDL cluster all in triglycerides. We included them as compliance markers. We know that triglycerides HDL change in predictable ways with increasing and decreasing carbohydrate. We saw that that was evidence that people were complying and to answer your question. The those two that we didn't look at everything we haven't yet looked at LDL cholesterol, and such but those two improved markedly on the low carbohydrate diet, triglycerides, decreased and HDL increased and those are key risk factors that relate to insulin resistance and metabolic syndrome, and that's a good thing to have HDL higher and triglycerides lower. Absolutely. In fact, the the ratio of triglycerides to HDL clustering is a key marker for metabolic health. How? Sensitive. You are to insulin. How likely you are or are not to get diabetes and heart disease, and this ratio looked best on the low carbohydrate diet, but a hasten to add we haven't looked at a whole range of other cardiovascular disease risk factor set. But let me just say that there is an extensive body of research on fat intake, and diabetes and heart disease. We know that some of the highest calorie highest fat foods around nuts olive oil of KADO real dark chocolate that despite their maximum calorie density. They look great for long-term, diabetes and heart disease risk. Compare those to the processed grains added sugar or potato products, which characteristically top list for weight gain and chronic disease. So Dr Ludwig in the very short time, we have left what should our listeners take away from the scientific findings of your study. Well, the the scientific findings are going to need to be replicated. So we can't make specific recommendations from this one study, but my view of based on the the strength of the literature in support of the carbohydrate, insulin model of obesity is that we want to focus on reducing the processed carbohydrates that invaded our Dieter in the low fat years so much less processed grains, potato products and headed sugar. You can still have plenty of whole fruits, especially the non tropical fruits, you know, not so much banana, but the whole fruits non starchy vegetables some root vegetables beans, small amounts of minimally, processed, grains, maybe a touch of added sugar, but to really emphasize the healthy fats, the ones we talked about, you know, others absolutely no reason to be consuming fat-free rather than full-fat trash. In fact, olive oil OB, you know, one of the most healthy things we can add to a meal of KADO nuts, dairy, if you're eating dairy make it full-fat, tastier. It's more satisfying. And then we wanna get an adequate amount of protein. But that doesn't tell us what what the sources, you know. Proteins can come from animal or vegetable products in one can eat a low fat diet with plenty of animal products, like Turkey breast, egg, whites low fat, dairy or one can eat a high-fat diet with plenty of plant products such as the healthy fats that we discussed actor David Ludwig. Thank you so much for talking with us on the people sperm ac- today. The pleasure to be back again with you. You've been listening to Dr David Ludwig. He's co director of the new balance foundation. Obesity prevention center at Boston children's hospital. He's also a professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard t h chance school of public health. Dr Ludwig has written three books for the public ending the food fight always hungry, and the cookbook, always delicious Lynne Segal produced today show would our ski engineered Dave Grayton at. It's our interviews. People's pharmacy is produced at the studios of North Carolina public radio W U N C that people sperm ac- thing music is by B J Liederman. The people's pharmacy is brought to you in part by Kaya deke's probiotic products made in Germany from Hypo allergenic organic ingredients, that's K A Y A -biotics dot com. If you'd like to buy a CD of today's show or any other people spire Masih episode you can call eight hundred seven three two two three three four. Today's show is number one thousand one hundred forty nine that number again, eight hundred seven thirty to twenty three thirty four or you can place the order online at people sperm ac- dot com. When you visit our site, you can share your thoughts about our conversation with Dr David Ludwig have you found success with a particular approach to weight loss? Tell us about it. In the comments section for today's show at the website. You'll also find links to the publications we discussed today in the B M J in science and in JAMA internal medicine. There's also a link to an article Dr Ludwig wrote for the LA times, titled the case against carbohydrates, get stronger at people's pharmacy dot com. You can sign up for our free online newsletter or subscribe to the free podcast of the show. When you sign up for the newsletter. You get our free to favorite home remedies in Durham, North Carolina. I'm Joe Graydon and. Terry Graydon, thanks for listening. Please join us again next week. We hope you enjoyed this podcast if so please consider taking a minute to write a review on tunes and thanks for listening to the people's pharmacy.

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Of Zebrafish and Diabetes - Healthcare Triage Podcast

Healthcare Triage Podcast

56:35 min | 2 years ago

Of Zebrafish and Diabetes - Healthcare Triage Podcast

"Hi, welcome back to the healthcare podcast. This podcast is sponsored by Indiana University school of medicine whose mission is to advance health in the state of Indiana beyond by promoting innovation and excellence in education research patient care is school medicine is leading Indiana university's first grand challenge. The precision health initiative with bold goals to cure, multiple myeloma, triple negative, breast cancer and childhoods coma and prevent type two diabetes and Alzheimer's disease. And today, we're gonna be talking about type two diabetes diabetes in general. Our guest today is Ragu MIR Mira professor of pediatrics and medicine at Indiana University school medicine, I'm gonna let him introduce himself. Thank you very much, Aaron I'm the ally. Lily professor in pediatric diabetes in the departments of pediatrics and medicine is school medicine. Fantastic. I wanna start basic could you just tell everyone. What is diabetes. Yes. Diabetes. I think most people understand diabetes. Being a disorder of high blood sugar, and it's affectively when your body is unable to utilize the nutrients that you take in and your blood sugars go up because your cells can't take up those nutrients particularly glucose, and and it's typically when you don't have enough insulin circulating or the insulin. That is circulating doesn't act. Very well. So what is insulin do so insulin causes yourselves, particularly your muscle and fat cells to take up nutrients, especially glucose, which is one of the fundamental nutrients. Okay. And so why do we need glucose so glucose is used primarily to create all of the components that are important in the cell. So they're used as fuel storage. They're used to create protein. It's used to create fat. So glucose is really a fundamental component of our nutrition and all living cells use it so annoyed. Normal functioning body that has no issues. I soon we eat food the body absorbs glucose from that food. What happens then so it it enters the bloodstream through the gut, and then the first organ that sees it one of the first organs that see it as the patriots. And when the pancreas senses the glucose that's present in what you eat it releases insulin along with that glucose, and then the insulin does what and then the insulin then travels throughout the body to different cells. And then it binds to those cells literally interacts with the cells, and then it causes those cells to send a signal that allows them to take off the glucose, so the glucose Romley go from the bloodstream into the cell. But if there's no insulin it just winds up sitting in the bloodstream crack, and that's why get super hot. That's right. And then the only way you get rid of it is through your P. And that's the reason why people with diabetes have such high blood sugar in their urine. So. Is the high blood sugar bad? Well, it's bad. Because as I said, the cells need the glucose to produce the nutrients, like the proteins and the storage form of energy. When can't do that your body, literally starves. So even though there's plenty of even though there's plenty of sugar circulating around your body starves because it can't take that sugar. Okay. So why would people not have enough insulin? Well, there several reasons for that. The first reason is that you could have an autoimmune disease that destroys the cells that produce insulin. That's what we typically call type one diabetes, but there are other forms of diabetes typified by type two diabetes in which your body does produce the insulin. But it doesn't produce enough. So that the cells don't really see enough insulin and take it up. So why I mean is it just an autoimmune disease or is it that they get that from? Earth. They get an infection. What causes the body to go after the that's a that's a very interesting question. And that's one of the hot areas of research today is why why does this happen and who does it happen in? And when does it happen? One thing we know is that typically happens to most people not in their infancy, but typically after one or two years of age, so that means that you're born without that problem, and then it develops over time. So we think that something in the environment must trigger that process. So that's one thing. Another thing that we know triggers the process of not producing enough insulin is what you eat. So if you eat very high fat diets, and you get obese you have a problem utilizing that insulin. I wanna stick the type one diabetes for a few more minutes, which type two so is it genetic is doesn't run in families. So it is genetic. We know that there are certain genes that are associated with it. But even having the jeans isn't enough. So we know that it does run in families. But it skips sometimes many generations. And sometimes you don't see it in brothers and sisters. So we know that you have genetic risk. But then beyond that genetic risk. You have to have some kind of environmental exposure could be virus. It could be something that we eat. We don't really know. Maybe something that we don't eat. So whatever it is that combination of the genetics and the environment, you know, just triggers this process and certain individuals. So does is it ever stop? Or once it starts killing off the tanker, sells it eventually kills them. All that's the thinking in general is that once the process starts. It's very hard to stop it. We've tried a variety of different drugs that have been in clinical trials to try to stop the process. They seem to slow it down. But in general, the process proceeds no matter what we do. How do we treat that? I know that just of it is give insulin. Clearly, but but is that the mainstay I mean is that just all we can do for type type one diabetes. The only real drug. We have right now is insulin. So how are things change stay in thirty or forty years because clearly we've been using insulin for a long time. So the things that have changed the kinds of insulin that we use. Now, we have an ability to find tune how quickly the insulin ax. We have the ability to also fine-tune how we deliver it. So typically, we used to do it by just syringe bottle drop insulin injected, but now we have a variety of different pumps that can inject it continuously. And even were moving to the point where there's very little sort of involvement of the individual himself or herself. Because now we have pumps that are connected to sensors and that they can use these fancy algorithms to determine how much insulin to give and win do people still need to correct for what? They're eating or is it gotten so good that now just runs on autopilot. No, you mean the pump systems. No, we're not that good yet. I think that's alternately where we're trying to go with a lot of that technology. We still have to do a lot of monitoring. We have to be careful what we and how much of the carbohydrates or fat that we eat. And and when we so all of these are still variables. So we're not quite at that. Stay not. I mean, it just seems to me that that we should be able to. I mean, if the pancreas is working by detecting insulin, and then releasing insulin in detecting glucose, excuse me. And then releasing insulin response to it. Why can't we set up monitors that detect glucose in the blood, and then just administer the amount of insulin for it? So we have those kinds of systems than reasons they're not as perfect as we'd like, partly is the technology. But the other part is the physiology because insulin goes right into the bloodstream, but when we injected it goes. Under the skin, and it takes time to reach the bloodstream the same thing with the sensors that we have for glucose is ideally, we'd like a sensor sitting right in the bloodstream where we can detect how much glucose levels are. But they're actually sitting underneath the skin. So it has to defuse, and then we have to use mathematical algorithms to figure out if the blood if the glucose in that skin is so much how much does that mean it is in the bloodstream so these are complex, and you can imagine it varies from individual individual shore. Is there any work towards I know artificial pancreas putting actually in there that would detect and then release inside the bloodshed. There definitely is as you can imagine any of those types of devices are more invasive, they're prone to infections and so forth. But you know, when we had these large devices that that that can actually be sitting inside of, you know, the bloodstream detecting everything, we know we can control things much much better. So. Where where's the sort of research going for? I don't want to type one diabetes. Where's the research going and type one diabetes? I mean is it just to refining the way that we deliver and technology. Let's call it. How how can we better deliver and sense glucose and and deliver insulin? So another area that people are getting very excited about is creating new cells that produce insulin. And there's a couple of ways to do it. So one way is to trigger the body to produce new cells. We know that these cells exist, we know that you're born with them. But then the immune system kills them off. Why can't they grow back? So part of the research in particular research. My live is doing is trying to figure out how come we cause these cells to grow again? And then if they grow again, then then the other question is how can we get them to evade the immune system? So those are things that we're working on. Another approach is a transplantation. So we can take cells from your skin convert them into insulin producing cells, we can give those house right back to you without immune suppression. And they could produce a lot of insulin. So we can do that. We just haven't gotten to the point where we can produce a pure population of insulin producing cells that the FDA says a safe enough to give back to you. But that would seem to be cured. If if you could I think either of those that I had just mentioned growing your own cells in their native pancreas or being able to produce new cells from your skin would be curative out to think we're close to that. Well, I think that we have challenges. So for example, if you can cause your cells to grow again, or cause those cells from your skin to become insulin producing cells. How can we ensure that they won't become cancerous? Right. Right. So that's a big concern because causing things to grow. So we're worried about that in animal models. When we do this. They certainly cure diabetes. But then, you know, long-term animals don't live very long humans level lot longer. So how can we ensure that we don't cause cancers or tumors? So I think that that is going to be one of the biggest hurdles to ensuring that it's safe enough for delivery into him. And so we have the technology the biologic technology to do this. The the challenge is our safety. How do we get there? Like, what do we need to do to ensure that need long-term trials or is it? No, it's not going to be long term trials because even trials we have to make sure that it safe in worse. Right. So it's going to actually be more technology. So if we can cause a sow to grow how can we control it? So can we cause that cell to stop growing when we want it to stop growing? And so now, there's a lot of using gene editing technologies that people have heard about and other sort of fancy. Molecular tools are able to try to control. Oh, that tempo of growth of these cells. And then literally be using genetic switches to turn these cells off when we want them to. So that's where some of that technology from the molecular side is going. It's fascinating help out. Is there any working towards if we can catch people before the entire pancreas has gone to stop the stop the destruction of final sells? That's another area where the school of medicine school of medicine is focusing a lot of its efforts. First thing we need to do is identify who's going to develop diabetes because the risk of developing diabetes is pretty small it's less than one percent in anybody. And even if you're high risk meaning that you have the genetic risk. It's still maybe two to three percent in your lifetime. That's not a lot. But it's enough that you'd say jeez. I wish I had a simple blood test. That can tell me I'm going to get diabetes or not. So part of what we're working on. Now is denting blood test because we're gonna dentist by a blood test. That says, hey, your likelihood of getting diabetes in the next five years is very high. Then we could potentially than us medications that can turn off the immune system or temp at down to prevent that from happening, which of these avenues we've talked about. You think is the most promising is is that the replacement cells. I think they're all promising. I think that's part of the reason why there's so much effort put into all these areas in prevention in technologies and then in cell replacement, and so there many funders of this type of research, the national institutes of how eighty are f the ADA a lot of private organizations are putting money into this. So, but they're doing it in a way where they're saying. We're not putting all our eggs in one basket. And I'm also struck by it seems some of them are. Men are geared towards how do we find a good way for you to live with this versus curative, which is completely different? I mean that would just be amazing. Well, I think curative is you know, the long term goal, but managing diabetes is the short term chore. How do we keep people with very brittle? Diabetes blood sugars, go up, they go down one of the biggest risks in diabetes. I mean, certainly there complications we talk about him kidney disease, I disease, but the real big risks are low blood sugars because they can kill people very quickly. You're driving your blood sugar goes low you get into an accident, for example, or your slightly older. You're an elderly person you have a low blood sugar having a heart attack. So so what we're trying to do with a lot of the work. That's literally hitting you know, people today is how can we manage the blood sugars better keep these ups and downs? How can we predict low blood sugars? How can we prevent low blood sugars are there better insulin's that can prevent that. So that's really the direction that we're going in right now that can affect somebody year from now, whereas the cell replacement probably looking realistically ten fifteen twenty years. So most people diagnosed with type one diabetes when their children. So that's what we used to think. And we used to call it a disease of childhood. But I think what we are learning. Now is that type one diabetes is a spectrum of diseases. It it becomes most obvious and children, but adults get it too. And we often misdiagnosed them as having type two diabetes. And then what we learn over time is that they actually slowly behave more like type one. And so what we're learning is that depending on the age in which you get it the severity of the onus the the repeatedly of onset of the onus varies so older. People might have the disease and not recognized. It's type one diabetes are like to shift gears. What's what is type two diabetes, and how is it different than type one so type two diabetes. I think most people associate type two diabetes with obesity. Uh-huh. Right. It's not exactly completely true. But it's true for the majority of people and what we know. Now is that when you get overweight and obese your cells for reasons that were still figuring out don't seem to respond to the as well to the insulin that you have. In other words, your body needs to produce more insulin to get the same effect. It would get if you were lean. So it's not as much problem with the pancreas cells to produce insulin as all the rest of the cells that are necessary to absorb it. So a little of both because it turns out that you can imagine if you can climb up a hill the higher that hill the slow harder it becomes to climb because you poop out, right? So if. The pancreas is trying to produce a lot of insulin because the cells don't respond to it as well. Eventually it poops out. So if we had a really powerful pancreas that can produce as much insulin as we need despite how how much the body needs. Then you wouldn't have a problem. So why do we associate it with obesity? What why is it wisn even matter? So it matters because the majority of people that have type two are obese. Okay. But there are people who are thin that can also have it because they have other reasons for this resistance to insulin. What we should call it. But it is also the case that people with type one diabetes can be obese is well, and for that reason sometimes we miss associate that disease as being type two. So so the the reality is that as the population is getting more obese the the prevalence of diabetes is getting greater and so we. We know that what you eat. How much you eat, and how much you weigh have a direct impact on how whether you are going to get diabetes or your risk of diabetes. So how do we treat type two diabetes? And how's that different than I want alternately, you can treat type two diabetes the same as you treat type one. So you can give insulin. But because as I said your pancreas still produces insulin. There other drugs that we have that can help your pancreas. So we have drugs that can cause your pancreas to produce more insulin. We have drugs that can actually cause your body to respond to the insulin better. And then you know in any kind of lifestyle changes you can make to reduce weight can help as well. So things that those things you can't do with type on why does reducing weight help? So what we know is that when you reduce your weight, your cells become more sensitive to the amount of insulin that you're already producing. So the amount of insulin that you're making. Ng then acts better. Why is that what we know is that as you get more obese your cells when they see insulin. They have to you know, what we call in the molecular field transducers that signal what that means is it has to see the insulin. And then has to convert that insulin in a way that can allow that cell to take up the glucose, right? So it turns out that at that molecular level when you get obese for reasons that are unclear still that ability to transducer that signal that ability to see that same amount of insulin and caused that cell to respond in the same way is impaired. So people can lose weight can they cure their type two diabetes. So many people who lose enough weight can and fact be free of insulin free of any medications to control their diabetes. Do we say their diabetes is cured? I I would say it's hard to say. Say that they are cured sort of once you have the disease you have the disease, which means that you're always at risk forgetting it again. So I what I usually say to my patients is that. I encourage them to lose weight because then they don't have to take all these medications, but they have to keep that way down or the diabetes will come back. What are the other types of medications besides insulin that we would use? Yeah. So there are other injectable medications. They're not insulin. But their medications that you can inject in that literally caused the pancreas to produce more insulin. Some of those medications also cause you to eat less. So you lose weight, so those classes of medications called GOP one receptor agonists, so that's one class and it's an injectable medicine. So is that a one day injection or is that every time you eat type of injection? So that is either a once a day or once a week. So you don't have to inject that every time you eat. So that's actu-. Early. A reason why that drug is very popular in it gets used quite a bit. So it is a popular medication. But again, people sometimes require additional medications beyond that when that doesn't work, and what are other types of Medicare. So there are pills that we can take for it. So we've got pills that can cause your pancreas to produce more insulin. Those pills have been around for decades. We know they work, but the problem with those pills, they're called self Anneli, they caused people to gain weight, and that's not as attractive as some of the other pills that we have now. So we have another pill. That's also been around for decades. Many people know it it's called metformin. It's a tried and true medication. It's relatively inexpensive. And in fact, it we call that either a weight neutral or slightly wait negative drugs. So it could cause some people to lose weight. It doesn't stimulate the pancreas to produce more insulin. But it causes your cells to respond to the insulin better. It's very good medication, and it's well, tolerated by most people, and then we have other pills that do similar things, but maybe not in the same manner. So we have medications called DP four inhibitors drugs that inhibit an enzyme and that cause your body to respond a little bit better to insulin. We have another class of medication called SGLT two inhibitors and what they do is. They basically cause your kidneys to just get rid of the excess blood sugar. So your blood sugar's fall, but largely because your kidneys are getting rid of more of it each of these medications works, they lower your blood sugars and in large part, they can protect you even from getting heart disease and some of the other complications of diabetes, but they each have side effect profiles that work well for some people and not well for others. How do you decide which to use? So I think that there are many ways people go through algorithm. So to speak what we like to do in our clinic is personalized therapies, so we like to ask the very simple question. You know, what are the features of any given individual. Maybe there are psychosocial features. You know, there's things that some people are afraid to use needles. Some people, you know, like taking pills once Dave versus three times a day. So one of the things we liked to do is personalized therapy as much as we can we like to go with inexpensive therapies or some people that don't have, you know, a lot of disposable income that they can put in medications, and they're very tried and true drugs that that that are very inexpensive. We tend to like to start with pills, okay for type two diabetes and we'd like to start typically with metformin because it's it's cheap. It's easy to take you have to take just twice a day. So that's. Good pill to start with. And I think for the most part we like to start almost everybody we can on that pill, and then where we go after that. I think is you know, on a case by case basis. I think we'd like to keep people away from insulin for as long as we can because many of these medications are as I said can cause you to lose weight insulin by the time you get on insulin. Most people start gaining weight on that medication. So we like to avoid it. If we can someone with type one diabetes constantly monitoring their blood sugar adjusting, their insulin is the same kind of mechanism and type two you have to keep checking your blood sugars or more, you take the pill, and you just hope for the people are on pills. We don't require that. They check their blood sugars frequently. It's nice to have them check their blood sugars just to see where they're at. But you know, what I like to do with blood sugar taxes? I, you know, people will do blood sugar checks when they know that they have to respond to it. If you're just asking someone to do blood sugar checks three times a day, and they do nothing with that information. They're less likely to continue their blood sugars, so so people on pills. I don't necessarily ask that they check their blood sugars three times a day. But somebody who requires injections where they need to use that information to determine how much insulin to inject. We do require asked them to check it three to four times a day so type two diabetes. You hear more and more people talking about what you should try to prevent should try to stop from having. How do you prevent someone from getting diabetes? So one thing we do know is that lifestyle intervention can prevent the disease. Probably is the best thing we can do to prevent the disease. So obviously diet and exercise can and has been shown to prevent Taibbi eighties. Right. The problem is that most people can adhere to these types of regimens for only so long. So the reality is that what we're not doing is preventing. Disease delaying but a delays important. None the less. It's less time. You live with the disease. They're probably medications that can help as well. So met forms of medication that when used perhaps an individuals who have prediabetes can actually delay their progression to diabetes. What do you mean by prediabetes? So we defined diabetes, very strictly by blood sugars. So if your blood sugar is less than one hundred fasting in the morning, we say that's a normal blood sugar. If it's between one hundred one hundred twenty five we call that prediabetes. And if it's over one hundred twenty five we call that tubbies. So there are basically three different states. You could be and we know if you take all the people with prediabetes and diabetes combined. That's probably close to fifty percent of the US population dough my so fifty percent of all or is that fifty percent of adult, sir. Fifty percent of everybody overall. All in different age groups that can it can vary part of me, you know, the FDR saying well fifty percent people have something then it's normal. Yes. It's been increasing. Okay. It's been increasing. And so, you know, these data have been coming out from smaller scale studies that then are extrapolated into the US population. And so so a lot of them. Now, come from better data that that result from not just fasting blood sugar measurements. But from what we call oral glucose measurements. So we give somebody a a load of glucose, and you measure their blood sugar over time. And so many studies have collected these data, and when you go back, and you look at these data what you find. When you separate across age groups is that over the years, more and more people have been falling into the criteria of prediabetes and diabetes. So and many people don't know they have it. Right. When we say lifestyle changes, and we say diet and exercise we we talking about something radical. Or are we talking about, you know, exercise, the usual, thirty minutes a day five days a week and. Just eat healthy. That's basically what we're talk is. Always fascinated me. Because that's what we tell me what to do anyway. So what's the point of checking for prediabetes? And then tell be able to do it instead of just saying doing any, and I think that makes it great deal of sense. Absolutely. So you know, there are symptoms today. Beatty's? And so I think certainly if you're aware of those symptoms that you should definitely inform your doctor feeling thirsty all the time frequently urinating getting up in the middle of the night to urinate fatigue. Those are things that could be a sign of diabetes, but they may not show up so easily in many people because the disease just progresses over time. And so they don't notice these things happening. So, you know, obviously having a good lifestyle can prevent this. Do we screen everybody? No. We don't screen every you go and see your doctor two in the afternoon. We don't you're not fasting. When you walk in. So we don't do tasked routinely and people that says, hey, you have prediabetes. Diabetes. But there are some people in which you can probably predict might be at risk for prediabetes. Those are people who leave sedentary lifestyles were overweight. Those are individuals that you've probably can say, you know, there's a strong likelihood you could have prediabetes. And if you think you're going to do something about it could be worth checking, otherwise those people that you would say this is a good time to start leading a better lifestyle. Is there any diet? That's better than any other. So diet is very controversial area depends on who you talk to him. Right. There are some people that advocate, you know, low carb diets key Todic diets, there's a variety of different diets the American diabetes association, which is really sort of the, you know, the professional authority in this area has no specific. Conditions on which diet is better than another. Because the data are controversial anyone that you look at. I think the the bottom line is it's better to go with the diet that you can stick to right because you know, if you don't if you if you basically are being asked to take a, you know, a very high fat or high protein diet, and that's not what you normally eat the chances that you'll adhere to that or much lower. So where's the cutting edge stuff and type two diabetes right now. You know, a lot of the cutting edge stuff is in new medications right weight loss medications, we know that losing weight can have a dramatic impact on diabetes. So there are, you know, obviously, drug companies that are working on a variety of different than new drugs, and you probably know in the past decade, the number of new drugs for type two diabetes has been coming. Probably every. Couple of years there, obviously new drugs and the goal of many of these drugs is to lower blood sugar without increasing weight. And that's a big goal. The other goal and type two diabetes. Medications is that the FDA requires that many of them be tested longer term to look at risk for cardiovascular disease. Right. So we're not looking to reduce it. We're just looking to make sure these drugs don't increase that risk to have some of the ones in the past increase the rest. Yeah. There have been some in the past that suggest that it could increase risk again. A lot of its controversial. We sometimes look at the data and relocate the data. So there have been a class of drugs that we don't use very much called thighs Ola dean dions teasing dis. And at least one of those drugs has been suggested to increase the risk of heart failure that's concerning. And then when we re look at some of that data. It turns out. Well, maybe wasn't quite as convincing as we thought the first time, but there are some people that will say that. It's correct. There's some people say won't even something as simple as the cell finale RIA drugs that have been around for decades and large epidemiologic studies suggest they may increase the risk of heart disease. So so there's controversy that surrounds them. But one thing we do know from a lot of these studies that have been done with cardiovascular outcomes is that some of the newer drugs may actually reduce the risk of cardiovascular disease in addition to making your diabetes better. So the SGLT two inhibitors, for example, seem to lower the risk of what we call secondary, cardiovascular events does sort of obesity surgery help with type two diabetes. So that's another area. So what we call bariatric surgery? There's at least three different types of bariatric surgery. And at least two of those three seemed to be very effective in causing weight loss. But even before the loss in weight, we see dramatic improvements in diabetes. What is what are some things are labs working on? So our lab as I mentioned earlier has been interested in figuring out ways, we can cause insulin producing cells to regrow, and so we've been working on looking at the molecular pathways, and then seeing if we can identify new drugs that stimulate those pathways to cause these cells to grow the reason, I liked drugs is that for most drugs. They can induce the growth of beta cells, and then when you stop giving the drug the betas growth stars. So it has sort of a benefit that you can control, you know, how much and how long those cells regret so with type two or you trying more to stimulate the cells there as opposed to Richard describing before was to get sell the body that weren't there. And that's what we're trying. To because we know that they're they're they're they're good cells. They still secrete insulin. Really really we need to go. After those cells that are there, whereas type one you just don't have those cells can is it that we're working you're working on this animals is that where you are. So we're working on it in actually three different sort of model systems. If you well one is to or model systems on his not, but we're working on it in we start in zebra fish. So our lab, the the nice thing is the zebra fish have pancreas like humans do actually looks a lot like human panther. They produce insulin. They can get diabetes. And but the nice thing about zebra fish is that they allow us to screen for drugs. So if we have a hundred drugs that we think might have an impact do we want to be giving all those drugs to mice or pigs or large animals because that's expensive takes a lot of time. How do we screen? So what we do is. We screen zebra fish. We can screen thousands of of zebra fish in a very short time thousands of different drugs. How did just how is that something? You're lab, desserts is just the known zebra filter something that are let figuring out zebra fish. So other people have figured out zebra fish. We've been able to incorporate the technique in to our particular research, so zebra fish are really convenient because they develop on the order of days, mice take weeks and humans take years. So the nice thing about zebra fish is imagine the human compressed down to just three days. And that's the period of time that we can do an entire study in zebra. And then you just put in the drug in the water. That's all we do. That's fascinate, and the zebra fish are not the kind of fish that you see in your tank there the larva so that tiny little things that you can barely see with the naked eye, and but they have pancreas. They have. Insulin, and we have a variety of different colors that we are now able to take zebra fish with where we can color, the different cells. So we can actually see this growing in real time. We and the nice thing about zebra fish. They're translucent. You don't have to kill zebra fish, actually, look at its pancreas. So so you're not actually been sacrificing them to look at the Panthers or what we're watching them right under the scope in real time that it really is. It's really cool. And when we find drugs that work in that model system, we then like to move to mice mice are rate model system to work with they take longer, but we have good models of type one and type two diabetes in mice. And and I think that in the in the world of the pharmaceutical industry that is sort of the gold standard gotta show something in a mouse. And if you can show it in mouse, you don't often even have to go to any larger animals, you can go right to humans. How do you give the mice diabetes? So there's a couple of ways you can do it. So like in humans, you can cause a mouse to overeat. Okay. High fat diet they get obese and and they can get diabetes. That's that just like in humans and that takes about eight eight to sixteen weeks in that range to to get a mouse become diabetic. But that that's pretty good. And then we also have mice have a hyperactive immune system that killed their own insulin producing cells, and so they spontaneously developed diabetes after about, you know, fourteen eighteen weeks of age. So we know exactly when they're going to get diabetes. So we can do prevention studies or we can do curative studies in those animals depending on their age. And you said you had a third system is that different. Or is it? Well, the third system is humans. Okay. So we do studies in humans and an a great example was a study that I'm collaborating on with Linda Maglione, who's a pediatric endocrinologist who. Studies type one diabetes and believe it or not it started in zebra fish. So we identified a drug that is used today. Clinically in certain cancers that in zebra fish seemed to be protective of the insulin producing cells, and when we showed that we then moved into the mouse model, and we showed that we could feed these mice for four weeks for a period of time before they develop diabetes, then stop the feeding and then their risk of diabetes is reduced dramatically. And then because the drug is already on the market. And it's and it's marketed as a drug called f Florida theme we were able to use a low dose of that drug. Get file what's called a in a investigational new drug application to the FDA. And and then we did a dosing study in people. With diabetes and with the simple goal to find out. If we gave this drug for about six weeks in these individuals, can we see an improvement in insulin. Secretion do you? So we don't have the results back yet. The study is almost done. It was funded by the J D R F, and and it was done at three different sites. One here in Indianapolis, one in Milwaukee and one in buffalo, and and so those three sites recruited patients put them on the medication for six weeks. So we'll have that data probably by this time next year. It sounds like with the mouse model it was somewhat prevention as well though. I mean, yeah, that was what we were doing. So we're not doing a prevention study in humans, although that's the direction that a lot of people are going is in prevention studies, and what we did in this human study was asked to simple question, if it can prevent diabetes in the mouse because it protected the beta cells, which are the cells that produce insulin. Can we give? Them to humans with the disease and show some improvement in the function of those cells, and if we can then that would sit strongly suggest it could work, and then we would go and do perhaps a prevention study in this type two diabetes. This is type one. Oh, it's like one one. So so you're trying to bring back beta cells them from. Yeah. So that's interesting. So we're not trying to bring them back from death because that that would be hard to do. Right. But what we have learned with a lot of the studies we've done in humans in the past five years, we've been able to get pancreas from donors who've given their their pancreas to to sort of the scientific community after they passed away that even though we think of these cells all dead. They're not even somebody said diabetes for fifty years. There's actually insulin producing cells floating around not a lot. But they're they're in the pancreas. So they're not completely gone. And so what that means in our mind is that there's the potential to re-grow those cells. That's fascinating. How about just flat out Packers transplants? They worked pretty well. Pancreas transplants. Due reverse diabetes. There are some centers that do a lot of pancreas transplants are studs here in at you. And the people have had pancreas transplants. Of course, they have to be on immune suppression drugs, right because otherwise reject it. But those who've had a pancreas transplant on our stably on pink on that transplant are effectively cured of their diabetes. What about oral insulin? Can is there any movement in that? Yeah. So that's very interesting oral insulin. Insulin is not something we normally would give somebody or all right, right? You have to inject it. And the reason for that is that insulin protein. Yeah. And if you ingest a protein, your body breaks it up slow, right? But there is a thinking that that started many many years ago that suggests that if you can give somebody enough of it some small fragments of that insulin enter the bloodstream, and when it does it does something that call the is. Called tolerating the immune system. So that means that it it sort of educates the immune system to say, this is okay. The insulin. The insulin is okay. Don't don't go after it. Okay. So that it doesn't then go an attack the cells that produce it and that has been the thinking, so so it's a tolerance Asian technique. So it's not so much that you're taking the insulin to dose yourself within on us to teach the body to leave the pancreas. That's exactly what it home now works. So it's not. But there's been a lot of effort that's been put into that. There have been at least a couple of major trials the first trial. That was done. You know, you know, felt that well, maybe we just didn't use a large enough dose because it seemed like we might be there in in in preserving the the pancreas, but even the second trial that was done with a larger dose. There wasn't really a positive effect overall. And so I think. That a lot of the energy surrounding oral insulin is kind of fizzed out a bit. Where do we get all his insulin? When insulin was first discovered, the only place, you could get it was from animals, right? So pigs and cows. And so in the old days, they were you know, what we call beef and poor sign insulin. But even then did they have to sacrifice animal animal than just take what they could get in the pancreas, or would they have sort of them hooked up to machines and continental and get out, and it was all sacrificing the animals taking the paying out many of them would go to slaughter houses. Anyway, so you can take the pancreas out. And then literally you squeeze out the pancreas of all the insulin. That's in the and then you have to kind of crudely prepare it. And that's the reason why we dose insulin in units because in the old days when they made insulin. They didn't know how much they had because they had a lot of junk that came with the insulin. And so the only way they could measure insulin is by its activity and so. Now, we call that units and so ever since then we've kind of stuck to that dosing regimen. So we don't use milligram micrograms. Like, we do with every other we use the term units. Then, you know, a revolution came about in the seventies. When it was discovered that you can engineer bacteria and yeast and micro-organisms to actually produce the insulin and not only can they produce. So they can produce an insulin that identical to what humans produce. So now, you don't have to worry about, you know, not being able to take pig insulin because you have an allergic reaction to it. Right. So now, we produce human insulin. And then in the nineteen nineties came a new revolution. And that was well, you can take the human insulin you can tweak it a little bit. And when you do that you can change the way that insulin ax. Does it act fast? Does it act slow and so then ushered in in the nineties era of what? We call insulin analogs. And then now here we are in the two thousand two thousand tens almost everybody's on some form of human insulin analogue, or when did they figure out that we could take animal insulin and give it to human beings and inject them. And then this would work that happened in nineteen twenty two and I'm just like for a while just imagining it must have been incredibly difficult to to to engineer build up the system where you could produce enough insulin to actually treat decent numbers of people. So you know, that's where Indianapolis became famous. So the famous experiment was done by two researchers go panting. Invest in nineteen twenty one and they were able to take the pancreas out of a dog 'cause diabetes, and then extract the insulin from that pancreas and give it back to the dog and effectively in those days, they said cure the dog of diabetes. Right. And so they said, well, this should work in principle in humans and in nineteen twenty two the first Hugh. Human recipient received insulin in North America. And that was in the city of Rochester, New York, and and that that individual famous individuals names, James havens was the first recipient of this sort of insulin. And when word got out that the James havens, diabetes was, you know, quote, unquote, cured lily ally, Lillian company went to Toronto to effectively license the technique, and then to then bring it to the masses how many units of insulin. Can you get out of a cow's pancreas? That's a great question. Because again units are defined by actively. So it all depends on the size of the cow. You know, the technique that you use to isolate the insulin thinking like I started a magic how many cows they have to kill go. Probably, you know, they were you know, it's hard for me to say because we don't do it anymore. And I can't give you a number. Right now, there's about one hundred units per milliliter in a bottle of insulin. Oh, that's way, more than I thought. Imagine. Like, you get cowed kill it, Pinkus and ten units you'd get a lot more than that. Okay. Get a lot more than that. So right now, a bottle of insulin that you buy over the counter or not really over the counter. But in the pharmacy has a thousand units in it, so ten miles ten milliliters at one hundred units per milliliter tip. That's typical fastening. So why so expensive? Now, why is it like not just so easy to make cheap? It is easy to make it is relatively cheap. There's costs and production. There's Costin purification. There's cost and quality control. But they're not a, you know, unlike a lot of other drugs that go into the generic phase where it's produced by you know, you know, goes out of patent. It can be produced by anybody. And that brings the cost of these. Medications down not true with insulin's. There really are. No what we call. You know, third party, insulin producers, it's basically to comfort three companies in the country for the most part that produce insulin at Sanofi Novo and lily, and they kind of you know, are the only ones because they have gone through the trouble of setting up. You know, the fermenters that it takes to produce the bacteria or the yeast that produced the insulin, you know, and go through the entire process of quality control. Whereas, you know with many pills. It's not that difficult, right? Reduce right pills are easy to produce insulin's or more expensive. So we haven't really had any other players get into the game. And so what that means is that, you know, I it's largely the cost of insulin a largely controlled by three companies each company, and there's only three of them right now that produce these insulin's, you know, make insulin's that. Slightly different from one another and for different individuals. It's only that particular insulin that works really, well, we know why? Well, again, you know, it's because you know, everybody's a little bit different and their bodies react to these insulin's differently. Sometimes in some cases, it's, you know, some people have an allergic reaction to a particular insulin made by particular company. So they gotta go to somebody else that also some People's Insurance is, you know, have contracts which are companies, and and they'll say, they'll basically mandate, you know, if you want insurance coverage for this insulin you have to use this particular companies and Solent or this particular type of insulin from that company. No, I would imagine that this would be a market someone else would want to enter. Yes. But I think that there is an incredible up front cost in setting up the infrastructure to produce insulin at that at that sort of level. So somebody has to see that there is, you know, real. Value to be gained. I mean, this is a business. And and so the question is really is there going to be away to to pull one of these big companies, you know, off their thrown and then come in with a generic insulin. And I think there has been there's been encouragement for this. I think the FDA's encourage the government is encouraged, but there just aren't people willing to invest in it. So I think that that is a big challenge there is if I might add a company that is now here in Indianapolis that was brought in here by one of our recent recruits to the precision health initiative that I you his name is Michael Weiss, and Michael Weiss is world famous for deciphering, the structure of the insulin molecule, and and he started up a company with all the research that he's done where he has now produced what's called the heat. Table insulin. So this is an insulin. That doesn't have to be refrigerated consid- outdoors on your table. Top for months and still be fully active doesn't need to go in a refrigerator. So imagine what that means now to particularly parts of the world where refrigeration is not easily accessible is that it then becomes possible to give people insulin who could only get insulin under certain circumstances and certain times of the day. So that then you just need to engineer, the bacteria two to produce this particular kind of insulin fascinating. So given the many many options we've talked about today. How do you figure out which what each person needs personalized to them? So the precision health initiative, I use school medicine was really designed around not just looking at an individual and saying well based on everything that I know about you. This is the best therapy. That is. Really precision medicine that is just using good clinical site precision medicine is about really taking objective data on a patient. Not knowing anything about them personally, except for some data that you can obtain whether it's from their blood or maybe their weight or their height or something and say based on information that we have this is the best therapy for you because you're most likely to respond to this therapy. So part of that now is is about doing Geno mix studies. So let's let's just say that you had a clinical trial where you put somebody on drug a verses a placebo, and you found that there was a difference. And that the drug seemed to improve diabetes, but it only improve diabetes in a subset of people. There are still some people. Got the drug that didn't benefit, but the overall group showed a benefit right? So that's great. But that's still means that if I put somebody on that drug they may not respond, right? And so the question is how do you then teased down further to say, okay, that there are individuals within that group that didn't benefit and the reason they didn't benefit was because they had a particular gene that every time somebody didn't respond was associated with that, gene. Right. Right. So precision health can be interpreted in a way that says, hey, if we can sequence all jeans, and you're in your in your body, we can do that relatively inexpensive. Now, can we find a combination of genes that we know that you have that would say you just need to be on this medication or this medication? And the likelihood that you'll respond very very high, and we're working towards that. We don't have that. Now, we don't have that. Now, we're working towards that. So what the? Precision health initiative is about is taking maybe samples that have been stored from studies like that, right? And then doing not just genomics, but what we call functional genomics. It's not just the genes that you have. But the genes that are active or even other proteins that are circulating in your body. And using a combination of all of the stuff using what we call informatics to then tease out. You know, a quintessential set of what's called the markers that would suggest you would respond or not respond to a specific therapy. And knowing all that information, we could say that you should be on a combination of this pill and this pill, and then it's likely in six years, you're going to need this pill or you're going to need this injection. How far are we away from that? So I think we're probably a lot closer to that than we might think because we have the technologies to do all the genomics and functional genomics, we have, you know, blood and urine and other things stored up. From multiple clinical trials that you don't have to actually start a new trial. This you can actually go to the freezer banks, and then do these kinds of studies. And so, you know, you know, we have a very large bio Bank here in Indiana, Indiana, Via Banque that has stored a lot of tissue samples blood urine from people from different studies. And we have other trials that are ongoing here Indiana University where we've done that precision health initiative in part with in terms of diabetes is about going to those banks without actually doing all the studies over again and saying, you know, what can we learn today with the technology. We have now from a study that might have been done ten years ago. And so that's going on now that is going on now. Well, we'll look forward to hearing results in the future excited to report on them to regulate. Thank you so much for joining us learned to done as I said before as more results come out. We'd love to have you back. My pleasure. Thank you for having me.

diabetes FDA Indianapolis autoimmune disease ADA heart disease Indiana University school of m obesity Indiana multiple myeloma Indiana university professor Aaron patriots engineer Ragu MIR Mira professor of pediatrics
20 - Children and COVID-19 with Infectious Disease Expert Dr. Kristin Moffitt

Medicine, We're Still Practicing

35:05 min | 2 weeks ago

20 - Children and COVID-19 with Infectious Disease Expert Dr. Kristin Moffitt

"From. Kurkcu media. The. It's still here. Numbers are still climbing who would have predicted that the health and medical community would be at odds with the politicians on how we handle the climate of this pandemic. I. Know you think you heard enough about this covert virus but new developments are worth understanding and each of our actions and personal decisions will affect our families, our friends and our communities. In this episode, you'll hear some new covert nineteen facts that are worth your time. It's stuff you need to know. This medicine, we're still practicing I'm Bill Curtis. Of course, I my friend and Co host Dr Steven Tailback. He's a quadruple board certified doctor of internal medicine, Pulmonary Disease Critical Care, and neuro critical care and he's on the front lines of the covert battle out in California, for which we are eternally grateful Steve How you doing. Thanks remotely tuning in. Hey Bill. Good to see. And a very special guest Dr Kristen Mufid. She's an associate physician in the Pediatric Infectious Disease Division at Boston Children's. Hospital. And she's a multiple award winning physician and professor of Pediatrics at Harvard Medical. School. Christie is also affiliated with Brigham and Women's Hospital She's certified in general pediatrics and Infectious Diseases by the American board of Pediatrics Doctor Moffett. We'd like to thank you for breaking away in. Joining us today. All right. Thanks for having me. Tell me how is Boston Children's focused change during this virus Boston Children's like every hospital in Boston March and early April were all frenzied months as we were preparing like hospitals I'm sure all around the world for what we were anticipating to be a surge in Cova infected patients. It became fairly clear relatively early in the pandemic with data coming. Out of China that children did not seem to be suffering the same severity from this infection as older individuals in adults did we were not completely sure whether or not that data would hold true as the virus swept across the world. Luckily, that has actually held true but that should not be taken it all to mean that children don't get sick from this some children do get sick. From this some do require hospitalization in some studies up to a third of children who require hospitalization require ICU, level care. So Boston Children's was in a unique position in Boston as you know, Boston has an abundance of hospitals for people to choose from excellent hospitals, all of them, but Boston Children's is the only free standing children's hospital. There are several other children's hospitals in Boston but they all. have their physical spaces, their units, their hospital beds contained within larger hospital systems that treat adults. So a decision was made within the city for Boston Children's to be able you take care of all the after patients in Boston who required hospitalization so that the deatrich beds in those other hospitals that were within adult hospitals could be committed to carrying for adults with cooking seems like a good. Plan well, even you just mentioned that children are substantially less susceptible to this virus than people at risk of the children who do get seriously affected by this virus apparently more than seventy five percent of the fatalities in children related to this virus are those of minorities? Can you explain why that's happening? Yeah. That is very true. The disproportionate effects that this infection has had on black and individuals. That has been seen in adults is playing out very much children as well, and that's true. Both of Acute Kobe infections, and then as you may know, we were all surprised in the pediatric. Rome to start to understand this other entity called MISC or multi system inflammatory syndrome in children that seems to be overwhelming inflammation that occurs in children largely two to four weeks after a covert infection. So both acute colon and MISC are impacting minority populations in pediatrics substantially two ways that the most likely explanation is that children are most likely exposed in their households in in their communities, and those are exactly the households in the communities in which the adults are suffering the most serious consequences in highest incidents of covid nineteen infection. So I think that children really very much are reflective of that. So interesting statistic when you look at it, I know from the adult side, we certainly see in that population, there's a lot of multifamily housing multiple families living under one roof and that sort of social crowding a seems to have an impact but also of those people who are not financially immune. So to speak from the virus in that, they must go to work every day to feed their family. You can't be you know a day laborer and do. It via zoom, you actually need to show up in in any time. There is that expectation. There's not going to be a lot of social distancing at the workplace in. So we think that lower socioeconomic in general would be forced to continue their work in their jobs. In spite of the fact that the risks remain the same and the statistic is not percentages of people who get the virus it is a death toll of people who have the virus. So, is it biological that affects them differently or lifestyle or food or? Those are all definitely hypotheses that still frankly require investigation and I think that there may even be a multifactorial. For it. That is along the lines of what Stephen was mentioning is a difference in access to healthcare for these affected populations as well. It certainly is possible that there may be a biological explanation, our hospital in coalition with. The other hospitals are studying the genetics of children who are impacted by either severe ovid infection or by MISC but there isn't anything clearly being born out yet in terms of solid genetic reasons that make me immune response to these affected populations different. Necessarily, there's still some work to be done there. But as you suggested to bill the underlying potential complicating factors that might be called co morbidity in some are also higher in these populations and make them at higher risk in more susceptible to more severe sequentially of this infection. So this isn't new that we need. To find thousands of healthy people who are willing to take part in a trial for a vaccine, you're not vaccinating the people who are already sick crate. So there must be a history of being able to find people who are willing to participate in such a thing of go about finding these people. It's varied historically in terms of what the vaccine was being designed to prevent in terms of how dire the infection was and how much population was affected by a given infection but historically, some infections that especially the ones that were devastating to families and children. Families were very eager to participate in vaccine trials and bring those vaccines into children whether there was a monetary compensation that was offered or not. So I think that there will be families that are eager who be part of these trials I was surprised in our own front we're running a large trial Boston children's trying to enroll children who've had covid nineteen, and we're asking these families to bring their children. Back, our hospital for blood draws that they don't otherwise need and I really having done a number of clinical trials that involved research only blood draws was not sure that this was going to be an easy sell for families but I've been very surprised by how eager families are to contribute to the advancement of our knowledge of this infection and the response of families to enroll in study has been really amazing. What do you think the penetration of this anti vaccine sentiment is out there what percentage of the families that you are in contact with you feel are anti vaccine once we have a vaccine, what percentage of the population will accept it or looking at the other way will not accept it. Yeah. So I think it made me a little bit in terms of how unique to a CO vaccine and how that applies to a sort of anti vaccine population in general by reading that polls most recently about Kobe vaccine uptake are suggesting that it's only about sixty percent of the population that sound like. They are willing to go forward with vaccination, and that's even if one frankly is determined to be safe and effective in some of these larger trials which is concerning. So I think it's really going to depend on how data from these trials look for the public to be able to make informed decisions at that. What do you think about the theory that New York and Massachusetts because of housing being a little more crowded that there's a higher viral load that lends itself to a higher mortality as opposed to maybe a lighter viral load more of an outdoor lighter load causing a less severe disease. Yet that that may be part of it I think the other factor that started supports that Stephen is that the communities in Massachusetts that were hit the hardest when we were surging tended to be communities that were exactly those that you described dense housing multi generational homes so I think that is certainly a likely in the fatality rate in the severity rate that you just have this higher. Of individuals a higher concentration, potentially a virus and when a person is getting infected with a higher viral burden, they will have a more severe infection that being said, are you going to restaurants and if so only outdoor restaurants? Assuming that none that opened or that may be minimal that are open for indoor seating what has been your personal policy. Yeah. Massachusetts has opened indoor seating at limited capacity with lots of risk mitigation practices in place that being said I am still only doing outdoor seating me too I think the study that came out that showed it was like a two and a half higher likelihood for individuals to have dined in in the fourteen days before their cove infection. Exactly. So we're GONNA take a very quick break and we'll be back with Dr Kristen Moffitt. And when we come back, we're going to talk to her a little bit about the concept of surfaces and whether they're a danger, we'll be right back. A moment of your time. A new podcast from commedia media. Currently twenty one years old and today I like magic extended from her fingertips down to the. Era of yourself because the world needs you and every do gutter that asked about me was ready to spit on my drinks. Seniors were facing feel like your purpose in your worth is really being stopped me from. Piano. She buys walkie-talkies wonders to whom she should give the second. Love humans we never did we never will. We just find one rock climbing is that you can only focus on right now. And so are American life begins. We may need to stay apart, but let's create together available on all podcast platforms. Submit your piece at Kirk O' Dot Com, slash a moment of your time. So we're back did with Dr Kristen mop it and Dr Steven Tailback. Christie. Wonder if you would tell us whether I should still be alcohol wiping down all my groceries and for the male let's dropped off and when this first happened I was pretty relentless and if someone approached front door pretty much sprayed them down with alcohol, which has been your lifelong policy anyway as. Well it it has. It has this thing has worked its way into a Germaphobe heart but I have to ask you is the concept of surface transmission. No. Longer a concern is it just breathing in droplet? Where do we stand on it? Yeah I I, wouldn't say zero concern I. Think it has become abundantly clear that the overwhelming majority of transmission events occurring through the air it is. Still conceivable that if somebody who was had a high viral burden. So the day of symptom onset, for example, in they had just sneezed on a doorknob and you went and touch that doorknob within minutes afterwards and then went and touched your nose, your mouth, your eyes, you could infect yourself that way. But I think short of those kinds of extreme circumstances transmission through contaminated surfaces does seem less. I think you know decontaminating the now not sure that's necessarily needed. Although I will recant the story of my my cousin, who's a economic professor in New York when cove I broke out there he was at the grocery store and witness somebody sneezing into their hands and then picked up an apple looked at the apple and put it back in the pile of apples and he was calling me and saying, should I eat fruit again or not? I think washing our fruit anything that's not already in a package. You know any any fruit where you're where you're eating the skin I think washing it makes sense but I would have said that pre-cold said so. So, let's go back to our kids I'm sure we have lots of listeners who have kids that are going to school now because it seems like a lot of our country has invited the very young kids like preschool kids to come in and experienced school in these small pods. Students or what have you, where some of the older kids are now dealing with the online thing but you can't do that with the very youngest kid. So with the very young kids, what is your advice to parents for how they explain what's going on to their kids and tell them? Yes you have to wear pants and you also have to wear a mask. Yeah. Yeah. I think it's a real challenge. I think for parents to keep the conversations age appropriate and what that means really is to have conversations with them that they can understand that aren't scary to them and it's possible to do that and at the Same time make them feel empowered like they're contributing to being a part of the solution for this. So framing things in terms of these are the things we have to do to keep our friends safe to keep our teacher safe and so that your family stay safe. So you stay safe framing it in terms of these are the things that doctors are doing to keep themselves safe when they're taking care of patients and so you can do this to and be just like a doctor and helping someone to keep other people from getting sick any techniques for the post adolescents and beyond even the eighteen to twenty five set. To be take the perspective that it really is not going to affect me, and this is my time to enjoy my life and what to take my chances without really taking into account the impact that they're having another people. I think the message needs to change and the message then needs to hit the motivation that age group is motivated. They are just inherently wired to want to be with their peers to want to congregate to want to. They want to be able to go to their sports they WANNA be able to go to whatever it is. They do for extracurricular activities, their theater group. They WANNA be in classrooms on campuses with there. Here's. So the message there is if you can't do these things collectively to he transmission under control, none of those things are going to be available to you. Campuses are going to close classrooms are gonNA close basketball teams aren't going to be able to play. So getting out the motivation and really trying to target the messaging there is going to be more impactful with that age group. So speaking of that age group I understand that there's a terrible vaping problem and I understand that while vaping is never recommended under any circumstances. Apparently, it's causing teens and young adults additional risks of contracting covert. Why would that be? Yeah. I think that there are probably changes that happen in the cells that line the respiratory track from chronic exposure to some substances that people are vaping. It may not even be necessarily what they're intending debate maybe an additive that they don't even know as there that can be having a serious impact on the cells that line their airway in terms of the effectiveness of their response to this virus. We certainly see that in in our adults pulmonary population but I've I've seen it in, you know in adolescence and. Not just a high school college problem, but this is a middle school and even grammar school. Decker Steve Does vaping in general reduce your immunity. It increases your risk of pulmonary infections because you're remain protective source is going to be the respiratory epithelium. This will call seeded epithelium, which actually has these finger like projections that beat out and beat up word any particulate matter that come into your respiratory tree and if you're gonNA do damage to that primary mechanism yet will lend itself to having ongoing and worsening lung injury. It lends itself to increase respiratory infections you want to avoid vaping at all costs. Doctor Moffett can I just ask you when you picture someone smoking and they exhale the smoke is that kind of a good representation of what these droplets could be doing when someone is simply well. Blowing out in that kind of form in your space. Yeah. I think that the active excavation from vaping or smoking is probably a bit more forceful than are just sort of sitting here inhaling and exhaling, and if you want to see really amazing pictures of droplets, respiratory droplets, there are some researchers in fluid dynamics that have taken these like unbelievably slowed down time lapse photographs of sneezes. For example, if you haven't seen them that are enough to make, you absolutely want to live in a bubble. So Dr Mufid I wonder if you could tell me, do you expect there to be a different type of covid season this fall in Massachusetts, compared to California and Florida from weather standpoint I think that the impact of the weather on this virus does not seem to be very impressive. I mean if you look at the parts of our country that were surging when it was warm and we were in better control in places where it was cooler, I think it's really hard to say there may be a modest impact in terms of the virus actually having specific viral characteristics that make it may be more likely to cause infections in the cold weather but I think it's going to be more social determinants of cold weather that are. Going to put those parts of the country where we get cold weather at higher risks, we're starting to hear more and more about the viral load and how if somebody sneezes in your face and you get a large viral load, you might get a bad case of the disease on the other hand. This virus is very small and I know there's no such thing as just one or two. But let's say you got one or two viral cells. Are you still going to build up an antibody to the disease if you get a very small load? A great question it's actively being studied because it's such an important question and I think it still may be a little too early to say for sure. But there are data already that suggests that if you had a relatively mild infection, you don't mount at least the same antibody response that those with more severe infection. So those who get very sick from this infection seemed to have what's called neutralizing antibody with really the most important type of antibody to measure you, WanNa know how capable antibodies detectable in a person's blood after they've had this infection capable it is of actually neutralizing this virus in a petri dish and it does seem that those who had milder asymptomatic infection have. Much, lower levels of that neutralizing antibody in their blood levels that don't seem to last as long. Okay. Well, we're going to take another quick break and we'll be right back with Dr Moffitt and we're going to talk about long haulers the folks that get this virus and it appears that they have it for a very, very long term we'll be right back. Welcome to life done better listen to the weekly episodes where supermodel and health coach Jill young talks to some of the world's most inspiring women in health and wellness. It's the place for all the UNICORNS who strive to create a life on their own terms join us to explore, discover and create a life done better together. Listen and subscribe from Kurt Co Media Media for your mind. What we're back with Dr Moffitt and Dr Steven, tailback and. There's this kind of new term being thrown around long haulers people who've suffered from covid nineteen and do so chronically for long periods of time wizard reason why some have such long standing symptoms and even when they're healthier than others who should by all rights the more at risk you have these long haul can't seem to get rid of the virus ways that I think from the adult side what we see and it's it's variable because there are some people who seem to smolder along and get better, and then we do see that period of time of people smoldering along, and then they hit a critical time in day seven today nine. The. Completely compensate and they wind up going to our ICU and on many times on ventilators. It's rare that we find somebody who actually gets better almost completely resolved and then D. compensates it's not been my experience. If you're smoldering, you're on low level oxygen and you seem to be holding your own, they can deteriorate in that magic window of seven to nine days. One concern is that your? Body is doing its best to keep the virus at bay on because you do mount a response in maybe initially, you can keep the virus at bay and then with any war from the virus that starts mounting a stronger and stronger response, and then just overwhelms your ability to completely defend against it, and now you're feeling the brunt of it getting the better of you at least at that time. Kristie, what are your thoughts about that? Yeah. I think that there's been a lot of debate in the pediatric worlds because we were. So surprised by this semi Sei entity, this multi system inflammatory syndrome in children that seems pretty clearly to occur about two to four weeks after an acute cove infection, and frankly in the majority of children who've experienced MISC, their acute infection was very mild and sometimes even as symptomatic. So we are often relying to figure out whether or not a patient. Is Experiencing MISC, they present with symptoms of fever and overwhelming inflammation. So they're hyper inflamed in that inflammation is affecting their body in different ways, but there are a number of other entities. That can look like that as well. So we're relying on whether or not. They still have a positive piece tr for covid in their upper airway or whether or not. They've mounted antibody response yet took Ovid, what is the age range where that tends to hit yet? So the the median age is about ten to eleven, but it is being seen in some older teenagers and young adults and it is being seen in some even down into infancy. Christie one of the things that were apparently supposed to avoid if our kids get covid is giving them aspirin. Why is that? So Aspirin in the setting of specific infections in general, a handful of viral infections in general children has been associated with a very, very serious condition called Rice Syndrome that can severely impact a lot of your vital organs. So Aspirin in general is not recommended in children if children are experiencing fever from possible infection or discomfort otherwise than either AGRIPPA or Acetaminophen products would be recommended. Also understand for adults. Ibuprofen is not a good idea as compared to other types of Anti inflammatories. So initially, it was off the list now that I don't believe that there's any warning against non steroidal in the adult population, we tend to use tylenol for fever Bateman and for pain control just because it's easier on the kidneys and it's easier on. The stomach provided, you're not getting to the point where you're getting to liver toxicity, but it's much easier to damage your kidneys with a non steroidal anti inflammatory like Ibuprofen than it is to hurt deliver with Tylenol Mifflin thoughts about that on the pediatric side in general in Pediatrics for for pain. Ibuprofen, if you're over the age of six months, Ibuprofen has. Recommended just tends to be very effective particularly for fever reduction and as long as it's correctly in knock into higher dose or given to frequently children in particular tolerate it very well but acetaminophen products would certainly be an option to. So, I wonder if we could take a little detour here and talk to you about reinfection and what we know because when would think this has now been going on since March we're now in October I wonder if you could tell us if we know anything more about whether people are getting this virus for a second time, there was a lot of alarm thing with the first clearly documented case of reinfection. So the the trick to documenting reinfection is that you really can't rely on just continued positive are testing because some people stay positive for a very long. Time from their primary infection. So the first documented cases reinfection occurred in individual in Asia who was infected. I if I recall initially April march or April return from traveling sometime in the last month or so and only had a repeat Cova test as a travel screen for from having been elsewhere and tested positive but was a dramatic but they actually were able to sequence the virus from the first test compared to the second test to confirm that it was a different viral sequence in there for this was indeed reinfection is the virus mutating that much at this point. It's not that the virus mutating much but there were detectable enough different says to ascertain it was two different viral infections basically, and then the big question is was the primary infection that confer immunity on the second because you can reinfect me all day. Long if I don't have symptoms I'm probably not GONNA BE UPSET? About that. So I think with with that first case report, I think that scientists were relieved actually and said, well, of course he was. With the second infection in that just proves what we would suspect which is that the first infection confers immunity against getting very sick from this if you see it again but of course, not too long after that, there was the second case report of reinfection in which again, because of two different viral sequences they will confirm it was indeed reinfection in the individual actually was. Sick with the second infection, so everyone will meet. He took a little bit of reassurance from the first case report that was quickly gone away with the second case report but I think in general infections. It's not surprising now that we have millions and millions and millions of cases that we will see reinfection 's from seasonal coronavirus experience we know that even if you get. Some immunity from seasonal coronavirus its longevity is not such that reinfection is an impossibility but encouraging that it seems to be very low rates because I know I have not seen any patients came in at least at the hospital that had to be readmitted within would seem to be a new infection. So Christie if your best friend comes down with Cova and isn't bad enough. Yet, to check themselves into the hospital but this is your best friend, and now we have all these treatments like rim, de Severe and otherwise to Roydon and what have you do you recommend to your best friend that they begin a regimen to try to minimize the virus or do you wait for it to get so bad that they have to go to the hospital At this point, there's really nothing that has solid evidence to suggest taking it when you're only mildly ill is going to really have an impact on your outcome. So at this point, my recommendation would still be if you're feeling crummy, but you're still able enough to be at home that continued what's referred to as supportive care, which is hydration fever control making yourself comfortable would be my recommended if I for that individual. But if they're starting to feel shortness of breath chest pain, any of the myriad of symptoms should prompt a very, very urgent evaluation. Any patient that would come to the adult floor who is not requiring oxygen or Hadlow a mediator levels, low fat and low CRP things that we for better or worse we are monitoring. We will be sending those patients home. Doctor Moffett ice sat around with family the other day, and we were drinking some wine and I said, you know I can't taste this wine and of course, everybody laughs and said. Why. Is it that supposedly one of the symptoms of having covert is loss of taste. I have been reading headlines about some clear impacts of the virus directly on your olfactory cells in particular, which are basically our sense of smell cells, and our sense of smell is so innately linked to our sense of taste that whatever it is that the virus is seeming to target in our mel cells seems to be having this rather unique symptom I'm asked often, how are we going to tell the difference between flu and Kobe Nineteen? How are we gonNA tell the difference between other winter respiratory viruses in covid nineteen and My short answer is we're not there is so much overlap in the symptoms of influenza in. Kobe. Nineteen that it will be nearly impossible to distinguish the two based on symptoms alone with the exception of someone may be having lost their sense of taste or smell which seems pretty unique to covid nineteen. Do you expect that we're going to get some good news about treatments or vaccines over the course of the next six months or should we be digging in and assume that we just have to get used to this while? I think we will be getting good news. I. Don't know that I would assume that in that timeframe, it's going to be associated with a confidence that we can lighten up on what we're already doing but I think we will get good news I. Think the best part of the vaccine landscape is that there are over two hundred vaccine candidates in development over half a dozen in which have already advanced into retrials, and so the best vaccine outcome and I think even the vaccine makers would say this the best vaccine outcome is that there are multiple Kobe, nineteen vaccines that are shown to be safe and effective and therefore. You could move several into populations yet our world vaccinated more quickly than if there was just a single contender that came out on top, for example, that showed to be safe and effective that's the silver lining in many ways right to the global nature. This means that we're so many resources are being mobilized in being brought to bear this. The says it's not a an orphan illness. It's something that affects every country. Every person that I think is very encouraging and do you expect countries to export their vaccines to other countries in that event or just pass on the technology and the biochemical solutions that led to that vaccine? I think a lot of those discussions have already even happened in terms of how the vaccine development got funded. So a lot of the funding that was offered to support development of the vaccine was. Upon access in different populations in different nations. So I, think a lot of ways in which the vaccines will be distributed by the different vaccine makers is already baked into the cake in economic forces for free economies I think pushed in that direction as well. Right I mean it's better for the economy. It's better for that corporation to sell it to multiple countries. Why would they limit it? So I think in that regard, economics actually works and everybody's favor. So as we wrap up, I just want to ask you one question about Harvard in how you teach there what will be permanently changed in the way you communicate and what you communicate to your students from this experience with covert nineteen. I think personally for me as an infectious diseases physician. But I, think most physicians in general in all fields. Say This right now is that there has never been in my lifetime as humbling a public health events a public health crisis as cove nineteen I. Think of the Times in March when we were watching this sort of March, its way from China I think I personally still had some sense that we were. Going to fair okay that we would certainly see this virus come our way. We would see it start to circulate in the United States but that we would be able to keep it from becoming as unbelievably rampant as it has become and I think that I never could have expected in. So many people I think in infectious diseases in medicine in general never could've expected just how unbelievably destructive this pandemic could have been. So you may inject humility into your teachings at Harvard. Going forward. I think that this panic really struck a tone of just how much we don't have control over things that happen naturally and even when they're infectious, it's really been astonishing. Dr Kristen MOFFITT. Thank you for joining us today. We WanNa thank Dr, Steven Tailback Dr Kristen Moffitt and we WANNA. Thank J. P. Morgan Private Bank for introducing us to today's guest as well as last week Stocker George. Rutherford. So thanks Jamie. This is medicine we're still practicing and it produced by Moseley Music for we're still practicing composed and performed by Celeste and Eric Dick. Please send this episode to your friends and have a socially distant zoom cocktail with them and chat about it, and of course, don't forget to leave us a review. Catch you next time on medicine we're still practicing. By by everybody. down. Room Kirk. Oh media. Media for. Your. mind.

Boston Children Boston Dr Kristen Moffitt Christie Doctor Moffett Massachusetts Dr Kristen Mufid Dr Steven Tailback China Decker Steve ICU Ibuprofen Bill Curtis Cova infection Stephen Harvard Kobe professor of Pediatrics Pulmonary Disease Critical Car
Know Thyself: Precision Genomics and Pediatric Cancer

Healthcare Triage Podcast

41:24 min | 8 months ago

Know Thyself: Precision Genomics and Pediatric Cancer

"Hi Welcome back to the healthcare podcast. This healthcare chairs podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education research and patient. Care I you. School of Medicine is leading Indiana. University's first grand challenge the precision health initiative. Which we're GONNA talk about in detail today with both goals to cure. Multiple Myeloma triple negative breast cancer and childhood. Sarcoma and prevent type two diabetes and Alzheimer's disease. We have two guests today. One of them is returning. It's Jamie Ran Bargar. She's the Carolina Sims professor of Pediatrics and Pediatric Cancer Research at Indiana University. School medicine and joining her will be Karen pollock. She's an associate professor of pediatrics. At Indiana University School of Medicine and the Will Center for Pediatric Research. I guess that's the Herman. B Wells Center pediatric research. But both of you welcome thank you thank you so much. So we've talked to Jamie before who is an MD in a pediatric oncologist? But I wanted to talk a little bit with you Karen and talk about what you do and how you got here so first of all specifically what is your area of focus on research sir My background is I got a PhD at the University Kentucky and a so I continued with immunology training for my first post doctoral fellowship at IU and got very interested and using my basic research skills and applying it to to patients and getting a little bit more into the preclinical type of research. And so the Herman be well. Center had been established. I you and I did a second post-doctoral training fellowship of the Wall Center for Pediatric Research. And have been there ever since. It's a great training ground To really take your basic skill sets and start applying it to clinically relevant questions. So that's how I ended up in. The Wall Center was an interest that I had. So can you expand on that a little bit more when you talk about taking basic science and then applying because I mean I think most people think about you know basic science. It's either working. I mean obviously in a lab but Sharon small specific things people talk but they got into a niche. And you got to really focus focus so when you talk about taking something and then applying it. What exactly do you mean so? When I started my training it was as you said. Very kind of niche oriented. You worked on one element of cancer. Maybe okay but what's happened now? With more bridge between basic scientists and clinicians is that. It's become very multidisciplinary research so where you may have been on your own one little lane as you move up in your career to establish a successful research program you have to know a lot about many things and you can't necessarily be an expert in everything but you began to develop teams that you work with so I had very basic skills. Working in cell culture had a cells respond to specific drugs. We also do a lot of mouse modeling where we work with human tumor samples and so I was already Kinda do. I was doing all this type of work on the wall center working on various cancers and then Jamie and I started talking about five or six years ago to start bridging things a little bit more and that's when we started really the precision nomex program was starting so I started. You know really good. Basic skill sets working in the laboratory. But then being able to take that knowledge and start addressing clinically. Irrelevant questions that the oncologist will pose. I think lots of listeners will be surprised to know that that's not common in the idea that you're going to take research here and then try to figure how do we you know advance to the next level. Or how do we make it actually more clinically relevant is a relatively new thing In research and that some institutions are clearly doing it better than they used to but But it is amazing. How silo things usually are so I wonder if you could just talk about that a little bit? Yeah absolutely I think that's one thing that we are really proud of is that we're not working in silos so if you go to the wall center for Pediatric Research. There is a walkway that connects our research building to the clinical side and on each side of it. It says connecting research with kids and so that is a big mission of the well center is to really find ways to bridge that gap and the one way we have done. It is Getting a patient samples Sherline had cancer at Riley Hospital. Come in and in certain cases there is sufficient tissue to donate to research and so One example would be the Tyler Trent case where Tyler was able to donate to samples and it gets samples of course. Get the diagnosis done. We work with the pathophysiology department. When there is extra tissue we can bring it back to the lab and actually began to make different types of models To study these very rare relapsed. Osteo COMA THE CASE OF TYLER. Trent and so that is one connection. We have but it's even more than that. We get the patient tissue. We make models that we can study for years to come but we also analyze these samples and then talk with Jamie the ecology group about. How do we prioritize all of these different options? We have to look at different therapies to treat in this case Tyler. Trent OSTER COMA SAMPLES. So one of the things we wanted to talk about today is Specifically known as the Tyler Trent Model But it's a specific. I believe research model and way of doing this growing tissue with the patient that we actually know which is pretty rare. I think in pediatric research. Where most times donations are anonymous and not connected individual patient. So could you talk about that for a bit? Yeah A couple of things. I think the main thing is tyler himself. I think It was one of those situations. He was a young adult At the time you know. He's a freshman at purdue he Really established a platform and that he was so inquisitive about what was going on. And when we GET TUMOR SAMPLES TO THE LAB. We do not know who they came from because hip deregulation. Everything's de identify. We don't know anything. Jamie and her group may know who they came from. But that's how we go about the research business is that you have this. You know channel. I guess cavern between the two. You don't know the name but what happened tyler. Trent case is he was so curious about. Hey guys you know I know twice that I when I went through surgery. We donated a sample. Do you know what happened to that. And so Jamie and the group talked with Tyler. They talked with his parents. And you know said you know this is not typically the way it goes but you guys are giving us permission will contact Dr Pollock's lab and they'll break their code and so we already had the models so in that would've been fall of twenty eighteen. We had the models and Jamie said. Can you look that up? We've got permission and we're like we actually have two models from this one and these models are what we call well behaved in terms of. Unfortunately they're very aggressive models but every time you take that cell and put in the mouth a gross. It's very well-behaved model. So we already had to that we were working on. And so that's kind of how it went and then tyler was already so engaged Wanting to know what was going on. And it just went from there really. I got a bit surprise so I understand that one anonymity that they absolutely get it but I would think lots of people would want this to happen. That they'd want to know what happened with the with the tissue that they donated in what is going on with shirt and not the case. Definitely since since this has started there have been a couple of families that are particularly interested. We're very careful as anonymity. They we had a lot of law discussion. Four sort of making a decision about what to do in tyler situation and and how to manage his request Because we felt clear we felt strongly and clear that That this wasn't information that was could be used to help inform his treatment And at the time he was actually approaching end of life And and really felt like he wanted this information while he was still around to to see the potential impact that his donation and that the work that our team has done with his tissue and how that may be able to help other people so we went to his home to their home just a couple of weeks before he passed away and Had A long conversation with him including reviewing results that was was really really powerful. The families that do get involved. You can see it's really helps them And I think with Tyler's family we had lots of discussions about we had a lot of Press a couple of weeks ago and back in December and we have many groups asking as we want an update. We wanted update. We know that you all made these models a year ago. So what's been going on? And we were very cognizant of the fact that we have things to say but we want to be reasonable about what we say not over promise Louis but before that we wanna make sure that the family knows what's going on and so we held off on a lot of press releases until we had Kelly and Tony. Trent come down to the Medical Center. And we actually had a my lab meeting and Jamie joined as well and talk to them about what we had what it meant and I think that's one reason. The Tyler case went so well as we made sure we were always educating. It's not over promise. Totally it really is. Yeah because I know if it was my child I would wanNA grab hold of any everything I could but I think the trends have been so gracious and so They really listen And they asked questions and of course they've been in this for awhile but very special family right. It's helped us in a lot of ways when I would add that. It's not only impactful. I think for the families that are involved but it's incredibly impactful for our team absolutely especially yes been a really unique and special experience. I think to have interested families of kids with bad disease. Come into the loud brave for them. Bomb known there and sit down with our team. Nb So engaged gauged I think it really has given our team. Just whole new level of motivation Italy. Imagine to like it's yeah but silent before yes to have all the way to basic science connected to these are the patients that you are. Yeah trying to help. Never in a million never two million years did I think I would be going to the home of a child who was dying from Osteo Sarcoma like a life altering experience for them. Yeah but just you know the fact that the trance would come down there and be so brave to after their son is even passed away. Go into the laboratory and see their son cells growing petri dish that is. I still haven't totally process. I've that's A. That's yeah but that's where we are with really connecting all these things the basic scientists clinicians and the community. No that's that's a fantastic example. Here you have a tissue sample of cancer I'm assuming it's a particularly aggressive cancer. Which is why. Yeah so what? What does that actually mean to make models? What do you do with it? We have several different types of models. We make the ones that simulate the most of what's going on in a patient are when we take the tissue and we put it in a mouse model. These mice are They're Kinda special mice their immuno-deficient which means they do not have an immune system so you can take human samples and you can implant them into the animals and so we have a whole team that we work with that goes from the operating room and the pathophysiology brings a tissue. We actually had a case. Just last night was a ewing sarcoma and we have someone in the. Or WATCHING MAKING SURE. We get the type of sample. We need that. It's put in the right type of you know preservation media and then the samples. Come back to the lab and within a couple of hours they are already in the mice it can be very challenging sometimes to make these models but this this mouse model you can take very small pieces of tissue as an example would be Tyler second surgery was in August of two thousand seventeen. We got the sample in August but it took us to January of two thousand eighteen to have sufficient tissue growing in the animals so we could then start expanding it so in other words. You're trying out therapies for an act for justice for treatment purposes. Then exactly. It's it's still fairly early discovery. What we work on but the the beauty of the system is that we have Jamie and her colleagues backing us up and helping us prioritize what we should work on and what. We shouldn't work on because you can imagine and science. There are tons of questions that you could ask so in the tyler. Trent cases an example. Once we know we've established what we call xenografts is what it's called. We then molecular characterized that just like They did in the clinic to make sure we have the same mutational profile as the original sample and for the most part we do. We're able to take that. And so then we can look at that and start looking at. What are some therapies combination therapies? That are under studied that haven't been explored so Jamie is this. Is this the treat the individual like tyler or is this now we want to find new ways? Treat the broad cancer now. That's a great question. So so as Karen was describing Often the time from actually implanting the tumor in the initial mouse to propagating into a whole group of mice. That then you can use for a whole series of experiments can take many many months And so So this particular system isn't meant to inform treatment for that specific patient But being able to to correlate the results that we get in the in the animal model with what actually happened with the patient can be incredibly valuable So really this is. Research intended to inform future treatment options. So the idea is now. We have tissue that we took from Tyler and we now built other places while taking tissue from patients to build new mice models that then you can test therapies against and hopefully find out things more quickly than you would with humans is that yes and I think another beauty the system to is that we are establishing a an integrated database. Where you're going to have the mouse modeling data but it's also linked to the clinical history of the patient so it isn't like it used to be in the old days where maybe I walked down the the you know the lab hallway and said Hey can I get an osteo sarcoma line for you. I WanNa you know tested or whatever now who had a totally different layer where we have samples from Riley kids where they know their whole treatment. History clinical history and now we have the laboratory data and so what we're working on with the bioinformatics group through the precision health initiative is to in the computer link all of this data so over time you have more and more of these cases and over time it will clearly inform therapy and are the cancer similar enough that if you find out what works for one particularly aggressive form of Osceola Sarcoma. It works for other. There's certainly main drivers things that drive the cancers so what we find is there overlaps for sure but then their differences but we are grouping them until like different buckets like these are responders. These are more like a non responder wide as one group respond better than another group and you can do that at the genomic level and her the really big differences to what drugs the Kansas will respond to. There is I think in terms of the OSTEO SARCOMAS. We've found a a novel combination therapy that hasn't been tested and we find that in. Osteo so it looks like that might be the way to go whereas in Ewing's were not so sure about that even they have some of the same molecular signatures. There's clearly some differences. You testing different drugs or different amounts of the same drugs or both both interest. Yes yes and that actually is a A very insightful question Yes because we one of the challenges of doing this work is it's extremely expensive and so scientists are always looking for ways to find a cheaper way. That's going to really have predictive value of what's going to happen in a mouse model or a patient and so we do a lot of drug screenings We're we're looking for. What is the concentration of each drug in combination that works better and can we achieve those concentrations of drugs in the mice? And does that have any sense for a patient? So we're constantly looking at patient data for a particular drug and seeing what was the level of that drug they could achieve in the patient. Are we working in that range in the mouse model in the tissue culture so we're constantly going towards the human data when we can to look at concentrations of drug? Are WE IN IRRELEVANT RANGE ARRANGE? It doesn't have any bearing on reality. So why when you say it. Why is it so expensive too? It's kind of research first of all. There's a lot of regulation We have lots of supplies that we have to use You have to pay a lot of technical staff. I have twelve people in my lab that predominantly work on pediatrics. Komo's so it takes a whole team to really do it. And then in this era of genomics The price of doing all of these analyses is getting less expensive But a lot of the more experimental approaches such as had a tumor adapt to a therapy. That's big area that we're working in through the precision health initiative. Is the tumor adaptive response. Those types of tests are very expensive. We just got a data set back on actually the tyler. Trent model on okay. We can halt the growth of tyler cells but if we take them off therapy they start growing back. How are these cells adapting? And so we work with a core down at a you. Call the podium x corps and just to do one experiment just for the proteome analysis is GonNa be about twenty thousand dollars let alone probably the thirty thousand that we had to donate towards the mice and the drugs and all that so he gets expensive really quickly a lot of words that I need to ask about. So you said genomics I which is what I was thinking about when you said proteome mixed but we'll get to that in a second but when you say we'll check the genomics. What do we mean? There's lots of layers to that so where we start over in. The clinic is on a particular group of patients. They will do clinical grade genomic analysis. They actually take the sample and they ship it to a company and they can get you know it's called clear approved level it's a very different level. Clinical grade sequencing does not twenty three and me. We're looking yeah. It's not twenty three and me exactly and so The precision genomics team than they can take that data. How much ever they can get and that can begin to help. Guide some of the treatments that stop one over in our lab we will then look at the DNA to make sure the DNA. We're looking at out of our mouse. Model is identical to what they had in the patient and then we can begin to look at the protein level which is the level above the DNA level. So we've I've asked all the action this multiple guests and you've been really good so I'm hoping you're GonNa make me understand when we say we look at the DNA. There's a gazillion and that's the technical number Dna Pairs look how when we say look at the DNA. What are you actually like? Is there just a computer spitting out see? Basically what happens is the the genome of whatever product you present to the company or to our research lab. They have a way that they can take small pieces of DNA. That have been worked out ahead of time and they can find were these small pieces of DNA will align with all the test sequences and then you can begin to look at those sequences by amplify amplifying them up. So you have ways to go across the entire genome because of previous samples previous knowledge that you have and look at the entire sequence but isn't everyone in a different. I mean how do you know a lot of similarities so you have databases of normal people's DNA so even a normal person is going to have little differences anyway right. We're going to respond to drugs differently all these things so there is a lot of similarity so one of the filters that are bioinformatics. Group uses is called the thousand genomes but thousand normal genomes so they basically took either skin or prefer blood from a thousand people and they sequenced and they said this is our range of normal. Ohka and they take the normal and then they can filter it against the the patient. The other thing you do with a patient as you also take their personal blood so you have what you call their germline DNA so you have that and then you have their tumor which is called their semantic and you sequence both of those and then you can also compare it that way as well. That's okay that that makes a lot more sense twitchy because because I think part of it is that how do we know when we check someone against the thousand normals? What would also be just normal variation versus. This is bad. Some people can have a bad gene. And they're still normal right because it's in the context of their whole genome. Right so tyler. Trend is a good example. We found What we call copy number variations pieces of DNA have been amplified. There's like many of them. Instead of one mic gene. There's four mic genes for instance comic June so mic is a gene that encodes for a factor that increases growth of cells. Boca rapidly. Grossest growth of cells so and Tyler's case we found that he had an amplified mic. And the interesting thing that you can do with the genome. Ix is we got his samples in. May and August of two thousand seventeen. We made our models. We were like. Oh we fought refunding. This making implication. Once he's had this relapsed. Eventually we were able to go back to his original biopsy from twenty fourteen because they had stored a little piece of that tissue and we weren't really expecting it. But that nick gene was already amplified and his primary tumor. Okay so down the road. What Jamie and her group are doing is they want to find better predictors of relapse right up front so they can bring that into the equation. And I think that's where the science really is now. And when you say better predictors thinking we should start sequencing all the tumors AC- Brenton's at there was that type of mixed mutation to begin with exactly exactly. I think one of the key things while what we're doing now Clinically with patients at the time of relapse sequencing the genome really selecting treatments based on what seems to be driving disease on with the hope that that's more likely to be beneficial than randomly selecting you know. What a traditional chemotherapy drug that that is much less specific And we're finding that for some patients even in Tyler's case on they can have great responses to that But that's really scratching the surface right in the end we don't want these patients to relapse Because at that point those tumors have evolved so much and adapted so much that they are really good at finding ways to get around whatever we throw at them. And so you know in. Our main goal really is to to understand and to identify factors. That are highly predictive. Even people who clinically wouldn't predict would go on to develop a recurrence Just these signals that Satan. You need to watch this this kid a little more closely or a lot more closely or we need to consider modifying their treatment upfront to totally avoid recurrence at all. How do you change therapy to try to avoid current shirt and then? Why don't we do that for everybody off the way not? Yeah so I think the simple question to. Why don't we do that for everybody? Right now is we're sure what to do with all that information at this point Particularly in the setting of pediatric cancers becomes somewhat of an an ethical question. Right if you have a disease and you're treating vulnerable population right so a child For something that with traditional therapy we may cure seventy percent of that population throwing something new into the mix without having a clear rationale or having some way to predict that that patient you know for example A child with metastatic disease at the time of diagnosis. So not just a primary tumor but also tumor that spread to other parts of the body We know that that patient has higher risk and so certainly on there are sub populations. There are groups of patients. Where we know. It's okay and we. We need to be a little more aggressive. Because their risk of developing recurrent cancer is is higher But beyond that certainly with certain types of diseases in sarcoma is one of them We don't necessarily have a great predictive algorithm or or way to identify patients who are at high risk so. I'm also assuming that you know trying to do things to prevent recurrence. When involve a higher level of people that have a lot of bad side effects or problems that could potentially come from it as well? Certainly you know while many of the newer more molecular targeted agents Has a group of drugs often have fewer side effects than traditional chemotherapy? What we don't necessarily understand so well is the risks when we combine them with Standard Chemo Right And so yes. Our our concern is. Are we increasing the side effect profile Are we putting kids at risk However one of the things we're really interested in is in taking an approach similar to what's been done in diseases like breast cancer for a long time and that is something called maintenance therapy Where PATIENTS GET THEIR UPFRONT TREATMENT. And then transition onto maybe even a single agent for a prolonged period of time in hopes that this simple or more targeted drug can actually take care of any cancer cells. That are hanging out still on that. We can't see on scans or measuring any way And so that's our hope is to use the molecular profiling or baseline tumor sequencing to understand what's driving that disease. Select targeted therapy to transition patients onto when they're done with their standard chemo as a maintenance therapy fermo more prolonged period of time to evaluate whether that actually decrease risk of relapse or recurrence In in kids who we know when it comes back as bad. What do you mean by targeted therapy? We sequence a tumor in in particular a pediatric tumor. We can learn a lot about that that disease and the the cells that make up that tumor Including not only DNA level information. But also what genes are revved. Up Right Aren. A and protein levels to really understand. Are there particular cell growth pathways. That are making these cells grow and then drug companies actually are now producing compounds. Drugs newer agents that specifically target certain growth pathways As a way to disrupt that whole process so again rather than with traditional set are toxic. Therapy which I like to think of as as a big hammer right much less specific. We're actually going after whatever process seems to be a driver in this cancer growing so correct me if I'm wrong so I'd say like cytotoxic. Chemotherapy is mostly. We go after cells. That are just rapidly growing. And so when you talk about targeted therapies. It's not. We're not something so broad but we're trying to actually go after certain proteins or things that are getting developed in which increase what is says it instead of looking at the DNA. You're looking at the proteins that making. Yes and the proteins are really the guys that are either keeping things normal or really messing it up right. So mic is a good example in that In Tyler's case there was at least four copies of this And so he has a had a high level of Mick proteins you have DNA the gives you that first sequence and then you have a process called transcription that comes along and makes aren a which is intermediary and that are in a can be translated into protein. Says the very so you can see. There's multiple stops where things could get really dis- related and must up so intolerance case. In many cases look up. There are high levels of Mick Protein. Because that drives the cells to grow it can promote metastasis. It's a really bad guy when it's dysregulation. Why do we need promex and genomics good questions so there can be cases where you actually do have an amplification of a gene? But you don't make any more protein than normal person so that DNA level is just you know that technology is so well tune these days. It's pretty accurate and everything but it doesn't give the whole story and it's you can take samples that have been sitting around a while and you can get very good. Dna Out of them. When it comes to aren't a and protein of samples have been sitting around a while. Things start to get messed up and can be you know. It can be degraded and things like that but in the models we have were getting a samples really quick and all this and so we can really look to see if they are truly is protein does regulation meaning high levels of the protein affecting multiple growth factor. Pathways for instance. So then are we all. Are you also trying to develop the treatments? Drugs is my target. This or is it. You're you're coming up with these things and then reaching to the shelf of what already exists and trying to throw. That's that's the beauty of an academic center. We do both so we have you know. chemist biochemist at. Iu that work in the realm of very early drug discovery actually making new compounds to target pathways and cancer. That are just regulated. Whether is not a lot of drugs on the market. Rask's is an instance where we have folks that you work in many companies working on it too so you have that layer early discovery but it takes a long time for a drug to get to. The clinic said the precision. Genomics program are bigger focuses. We want to work on drugs where something's known about an impatience you know that's another challenge that. Jamie and her group have is figuring out the doses to actually use the pediatric patients. Because that. I'm assuming it's different. Sure absolutely absolutely you know. It's it's one thing in in someone like Tyler who's a young adult or or even an adolescent but certainly for thinking about The practical application rates actually using a new drug With limited experience and children in a five year old or three year old can be reality. I mean is it just a dose by weight or is it I mean. How do you figure that? Yeah so So often it's not a simple dosing weight or extrapolation down. We do use Body weight or more often body surface area to calculate dosing for for children The challenges that it's not often a simple extrapolation down from what would have been given her what is given to adults And so they're even after a drug is is in common use and adults Or has gone through. All the phases of drug development clinical trials in adults. We redo those in children with a more aggressive timeline. Right because more is known about the drug than than it was when its first introduced into an adult But certainly we have to go through. Very structured clinical trials To gradually work up the dose or increase the dose to to ensure that it safe And in some cases now even that we we see biomarkers or predictors of The fact that it's reaching biologically relevant concentrations. How when we talk about something Augusta Sarcoma I mean? How many drugs are there? Is it like so many? It's like so he can't think about it or is it like a handful so yeah so so when you talk about When we talk about US yes. Or Coma Certainly. There are handful of drugs that we use as part of OUR UPFRONT TREATMENT. And in fact that same cocktail or group of Drugs. has been used for over twenty years as we think about the opportunities for adding in newer compounds That becomes overwhelming. They're you know the the number of directions you could go certainly is finite but but there are many possibilities out there. Many many every caulking like tens or hundreds I mean I is. It could imagine or hundreds. Yup Yeah Yeah. Yeah and and what happens is You have you know different. Companies that will make a similar drug to the same protein but those drugs will have little different behaviors to them. Because I had so like one at one of the drugs that you know. We work well MIC as sample. Okay and you. There are no drugs that directly inhibit mick but there are drugs that will prevent the transcription of MIC on. Its Way to becoming a pro team. So you're indirectly affecting it and there are a number of these drugs out there and they all have little different nuances about them on how they're gonNA work how they're going to be metabolized. The body so we are constantly having discussions on which one said. We'll we'll we'll work with more them in tissue culture trying to understand the predictive value of these models. How can we prioritize the we probably have thousands of drug combinations? We've tested now in vitro on plastic so only a few of them even go into our mouse models and when we say when you say hundred which again. I'm still trying to wrap my head around because I didn't know that Is that for all kinds of cancer or are these are these like those are like hundreds of basically cancer drugs in general or is it. Okay General it's just as you can a lot of cancers as we said have similar pathways that can be disrupting the regular road. I only hear about a handful. Maybe it's just the ones they have commercials for but it's Well a lot are called a drug for a while and then they get to trial and they don't work and then they become what you call a research tool okay. So they get worked at worth in the laboratory a little bit more. And then if you figure find an actual use for it that's when they go back and they unless there was talk subsidy which is usually the biggest no go okay so translate into action to actual clinical care like now do how does what do we do with this now. To treat patients in terms of the therapies that we've developed looking at Tyler's so is it. Is it now that we you ask patients to get genomics proteomics and see if there are similarities? And that and that's how you choose different therapies. It's probably at least two pronged right. So certainly kind of as Karen described creating sort of buckets of of tumor types Or of maybe Australia Sarcoma buckets really based on the molecular profile. On what we see when we do sequence the tumors allows us to to. Maybe better predict how they'll respond and And to use that in the future not quite yet but in the future to help inform therapy really with I think some of the ongoing work now Where I see that going is a phase two clinical trial So a trial that would specifically evaluate a novel combination so in new combination of drugs to be used in the setting of Osteo Sarcoma. In this case. That comes back that recurs. We're not yet at the stage of Lake. Truly targeting individuals therapy but this is helping us to find new therapies and general for perhaps like aggressive sarcoma. Yeah we we do. Certainly we do target individuals therapy In a very In a very specific way on when we see them at the time of relapse And certainly you know We I think the work. That's going on in the lab is really helping us to refine our clinical decision. Making for those specific instances our goal Michael. Certainly as some of the work that that's happening in the lab now can actually be translated to Not only the setting of relapse but again potentially ways that we would modify therapy treatment at the time of diagnosis to avoid relapse and those require much. More structured clinical trials. You would figure that out by doing again. Genomics proteomics at that in the early on more than likely yes again with the idea that Modifying treatment for everybody doesn't necessarily make sense but certainly if we can relatively cleanly irrelevant predict kids with a high risk of relapse so many starting with a population That has disease at more than one site or metastatic disease at the time of diagnosis To then add in novel agents to their standard what we would consider standard treatment. If we're doing something we are studying or something. We should study so through our cooperative groups. The children's oncology group being the the biggest In the United States We Are. They're always ongoing studies of New Treatments. Often in the setting of relapsed disease But also even upfront treatment trials we consider them or we call them clinical trials that are used at the time of diagnosis where we make small changes in the what's considered the standard of Care Treatment To try to make it better. Those studies are always ongoing. The trials looking specifically at relapse disease. There always are a handful of those as well. and And I think that will continue. Our hope is that the work that we're doing can really help to move things along a little more quickly By giving US information to help refine our decision making so that we can pick we can do a better job choosing treatments to add in for specific patients if that makes sense so this has absolutely been fascinating and I will tell you that like I feel like I learned something so hopefully everyone else did as well but Jamie Karen can't thank you enough and I'm sure would love to have you back in the future to talk about advances. More things are going. You Bet thank you absolutely. Thank you again. This healthcare cheers. Podcast is sponsored by Indiana University. School of Medicine whose mission is to advance health in the state of Indiana beyond by promoting innovation and excellence in education research patient care.

Tyler Trent Jamie Karen cancer Osteo Sarcoma ewing sarcoma Indiana University School of M Wall Center for Pediatric Rese Indiana University Indiana Wall Center Karen pollock Pediatrics and Pediatric Cance US Multiple Myeloma Mick Protein Herman associate professor of pediatr B Wells Center Sharon primary tumor
Show 1200: Making Sense of Changing Nutritional Guidelines

People's Pharmacy

55:36 min | 9 months ago

Show 1200: Making Sense of Changing Nutritional Guidelines

"The People's Pharmacy podcast disappointed. In part by coca via cocoa via cocoa flavor knowles support both cardiovascular health and cognitive function by promoting healthy blood flow transporting oxygen and nutrients to vital organs and muscles including your heart and brain cocoa via now comes an even more concentrated formula with four hundred fifty milligrams of Coq. Au flavonoids five times more than the leading dark chocolate bar and fifteen times more than the leading cocoa powder cocoa via has a proprietary process. That preserves coca flavonoids at the highest levels and the product undergoes rigorous testing at every stage which allows them to guarantee the highest level of cocoa flavonoids per serving and to provide the purest highest quality product. Possible People's pharmacy listeners. Can now try coca via for twenty five percent off by using the code. People's twenty five at coca via dot com that's CEO Coo A. V. I A. Dot Com for decades. We've been told to avoid red meat. Then some study said the risk was minimal. What should we believe? This is the people's pharmacy with Terry. And Joe Graydon if experts can't agree about how to interpret Nutritional Studies House the public supposed to keep up with changing nutritional guidelines. It's not just read meter. Processed meat like Bacon are Rami. Some new research suggests that even poultry might pose a problem. Dr Aaron Carroll Helps US interpret risk. What should we worry about? And when should we relax Doctor Joann? Manson led the vital study which looked at the possible benefits from fish oil in Vitamin D. What did the data reveal coming up on the people's pharmacy making sense of confusing statistics? Welcome to the People's pharmacy. Terry Graydon Joe Graydon. Everyone knows that eating red meat is bad for you right except the data are surprisingly slippery a few months ago. Several articles suggested that meet might not be so bad after all recently. Another analysis showed a link between meat and cardiovascular disease for clarification we turn now to Dr Aaron Carroll Professor of Pediatrics and Associate Dean for Research Mentoring at Indiana University. School of Medicine. He's also director of the Center for Pediatric and Adolescent Comparative Effectiveness Research Dr Carols. Most recent book is the Bad Food Bible. How and why to eat simply welcome back to the People's pharmacy. Dr Aaron Carol. Thank you very much. Remmy Duck Carol. It seems as if food fights are the biggest controversy in medicine today. And you've written a really fascinating article in the New York Times as usual. The title meets bad for you exclamation mark. No it's not exclamation mark. How expert see different things in the data? Well tell us about this latest study about meat. It's got a lot of folks up in arms while there were a bunch of studies actually published Gosh it's gotta be like two couple months now ago in annals of internal medicine a group of researchers got together and tried to look at all of the evidence as to how meat affects health and they conducted a bunch of systematic reviews and Meta analyses. They looked at how diet with meat affect how they looked at how meat consumption and our mounts affect how they looked at relationships to death to cardiovascular outcomes death from those outcomes on the analyzed in a bunch of different ways and just what they found was that the actual evidence for a link between meat and health is small in absolute value and not of great quality with respect to the evidence and so based upon all of those studies. I think there were four of them. They wrote a set of recommendations and the recommendations basically came down to given that we know with great certainty about this link and the link appears to be very very small for most people. Most people can probably keep eating the same amount of meat that they have been eating for some time and as you can imagine that is quite controversial as it flies in the face of nearly every other recommendation from every other group. Which would argue that. We need to eat much less meat that meters associated with terrible outcomes including cancer including death including heart disease and that everybody needs to eat less meat and in most of those other sets of recommendations or guidelines from other groups red meat in particular and processed meat in double particular are seen as Particularly negative for health so eating for example a hotdog or Bacon. Oh my goodness what a sin. It just drives a lot of nutrition experts crazy. Yes quite sure that that the the links are real that the links are large and that if we could convince everyone to eat less bacon for example or eat less steak or a hamburger That we would see massive changes in the health of the population and so lots of groups are very angry at this new set of research and studies and took exception with it other groups supported it and thought it made you know quite good sense to to look literature and the researchers wet so Dr Carol. How can intelligent well educated people come to such different conclusions based on essentially the same bunch of data while we should? I say that you know. Even intelligent well-intentioned people can get quite passionate and tribal about arguments about these and that even when their intentions are good. And they believe that they're in the service of of Science and truth that they can become wedded to one side or the other in ways. That probably aren't productive but even with the best of intentions people are going to disagree on stuff like this. For a variety of reasons one is that we just only have a certain kind of evidence. The vast majority of research with respect to how do nutrients effect health is what we call observational research. Get a bunch of people together. We ask them what they've been eating for the last ten years we look at how healthy they are and then we try to correlate what they've been eating with health. The problem with that is numerous one is that it's incredibly hard to look at high risk outcomes because still in the scheme of things things like heart attacks and death in cancer are pretty rare. And so unless you're focusing on a very very high risk population do numbers of these bad outcomes that are current studies are pretty small and of course if you look at Irish populations that doesn't translate well to what happens to not Irish populations which is what recommendations are supposed to be written for secondly we because we have observational research. It's never going to be causal it's always going to be confounded and that means that you know people that eat a lot of let's say bacon might also tend to smoke might also tend to drink too much. Alcohol might tend to be poor might tend not to exercise. All of those things are certainly associated with bad outcomes and it might those might be the cause. It's very hard to tease out. What happens with one nutrient? Another problem is that while the relative risks can be high in fact the one that's often Mo- siders the processed meat serving process me to a will increase your risk of cancer by eighteen percent over the course of a lifetime. That's a relative risk that that means that compared to your old risk and went up eighteen percent but if you're starving risk was only two and a half percent then that eighteen percent increase musical from two and a half to three point two percent. That's not as big a deal as eighteen percent for most of these studies. The absolute potential risk increases are much smaller than that and so for an individual if the risk is only up by point five percent then then that means that if two hundred people make the change hundred and ninety nine will be unaffected. One will on the other hand. Some people argue. We should be looking at things at the population. Level that if we have a million people or two million people then that same risk increase might save ten thousand people. Of course one million nine hundred ninety thousand or unaffected but you know when we talk to individuals about what they should or should not eat. They care about their individual risk. A lot of people who are pushing some of these recommendations are much more focused on the population risk in the population level. That's not how individuals think on how people think and a final reason. I think the people will often good with good intentions. Really disagree about this has to do with you know. Should we take preferences into account? Some people really really like meat and it may be that they're willing to take that tiny absolute risk in exchange for getting the EAT. Lots of meat now. The counter to that is people will say well. We don't ask people if they like smoking. We unequivocally tell them smoking is terrible for you and you should never never never do it. But those things are not comparable. The the risk increase for smoking is on the order of like ten thousand percent or twenty thousand percent not eighteen percent and that's of course the relative risk people who smoke quite a bit will increase the risk of certain cancers by literally that amount ten thousand or twenty thousand percent when the risks are that high in that clear preferences shouldn't come into account but when they're small five ten fifteen percent in a relative risk and it might get infected probably arguably is reasonable to say that people should get choose. We take on risk every day. We drive we ski. We Scuba dive. All of those things are risky and yet we say it's okay because people adults can make decisions to take on risk if it's for things that they enjoy and for a lot of these things. The absolute risks are very small. Carol one of the challenges of course is that August organizations. You know the Food and Drug Administration the Centers for Disease Control and Prevention. The American College of Cardiology. The American Heart Association various organizations especially in the health field put out guidelines and one something is in a guideline. It's like if you're a doctor and you don't tell your patients not to eat meat. You will be spanked. You're not living up to the best practice of medicine. Tell us a little bit about you. Know moving from beliefs which is often where we start to guidelines even when the data changes. Well here's part of the problem is that they're eas- no one accepted methodology for producing a guideline in fact. Different organizations will often submit or produce. I should say guidelines on the same topic did come to different conclusions for that reason. Some organizations like the United States Preventive Services Task Force do have a much more rigorous methodology. Which is why a lot of the guidelines they put out come out with what is known as an eye rating like an a rating is like big effect. We're pretty certain. Listening to what we're saying. And A B rating might be smaller effect with certainty or perhaps a big effect with less certainty. But we're still pretty sure and then of course like a derating might be. Don't do this. There's there's just evidence not to do this. But a lot of recommendations get an eye rating meaning. We just don't know like we don't have adequate evidence to determine what to do. And for instance whether or not we should universally screen kids for autism which seems like a no brainer gets an eye rating from the US PS PF. Because they say we just don't have enough evidence to know what universal screening. We'll do so when it comes to something like should we eat a lot of meter. Not they'd probably say we don't really know the effect is small. It's not certain benefits and risks or even we just don't know what most organizations don't do that they wanna tell you to do or not to do something. And so they wind up coming out with with instructions. Even when we're not terribly sure and unfortunately this leads to reversals. For instance for decades certainly for years if not decades the USDA was telling people to limit how much cholesterol a day and it's only in the most recent set of guidelines that the evidence finally got up to them and they're like yeah cholesterol really non nutrient of concern. It turns out that what you eat in. Cholesterol is not the driver of cholesterol. So avoiding all those eggs probably didn't make much of a difference well but that's not what they said for decades for decades said. Oh my gosh you've got to limit your cholesterol. We gotTA BE EGG. Whites have to limit your shrimp. You gotta be really on the ball for this. There was never a hedge. There was never a well. We're just not sure the evidence it's always with certainty and unfortunately because I think organization speak with such certainty even when the evidence is only observational even potentially confounded even when the absolute risks are very small that we get stuck in places where it's very difficult to reverse themselves and I think that's where a lot of organizations are finding themselves right now after a long time of arguing. We are certain you must do this. It's very hard to turn around and say we will all you're listening to Dr Aaron Carroll Professor of Pediatrics and Associate Dean for Research Mentoring at Indiana University School of Medicine? He directs the Center for Pediatric and Adolescent Comparative Effectiveness Research. His latest book is the Bad Food Bible. How Y to eat simple. After the break Dr Carol will explain the difference. Between Relative and absolute riffs. Let'S THE NNT. And why does it matter? We'll touch briefly on statins cholesterol and diet. What actually makes a difference between? You're listening to the People's pharmacy with Joe and Terry Graydon. The People's pharmacy podcast is sponsored. In part by Kaya -biotics K. A. Y. A. -Biotics offers the first probiotics which are both certified organic and Hypo allergenic. I'll probiotics are produced in Germany. Under laboratory conditions with high quality ingredients and under strict regulatory oversight the three available formulas are created for very specific purposes such as strengthening the immune system fighting east infections and helping with weight loss to learn more about Kaya -biotics probiotics and the important topic of gut health. You can visit their website. Kaya -BIOTICS DOT COM that's K. A. Y. A. -biotics dot com. Use the discount code people for ten dollars off your first purchase. Welcome back to the People's pharmacy. I'm Joe Graydon Terry Graydon. The People's pharmacy is brought to you in part by COCO via the maker of high potency. Cocoa flavonoids supplements that support cognitive and cardiovascular health more information at Koko via dot com also by verizon an analytical laboratory providing home health tests for hormones gut health and the microbiome online at V. E. R. I S. A. N. A. Dot Com to they were trying to make sense of changing nutritional guidelines. Our guest is Dr Aaron Carroll Professor of Pediatrics and Associate Dean for Research Mentoring at Indiana University School of Medicine. He directs the Center for Pediatric and Adolescent Comparative Effectiveness Research. He's a regular contributor to the New York Times upshot column and has written three books debunking medical miss. His latest is the bad food Bible. How and why to eat sinful. Dr Carol you have mentioned the difference between relative risk and absolute risk and a lot of other. Our other guests have also discussed this. But you know I I would have to say. Journalists are in part to blame and in a sense. You're a journalist. I mean you do right for the New York Times after all but you know if you're a journalist and say the relative risk is maybe a fifteen percent reduction or a fifteen percent increase. That sounds kind of sexy. That almost sounds like it means something whereas if you say. The absolute risk was point seven percent who cares. I mean it's like Nah didn't do much. Why should I pay attention to this article the headlines GOING TO BE BORING? So how do we basically change? Not just the health professionals approach because they do the same thing when it comes to medications but also the writers journalists and then hopefully the readers who really will begin to understand. Oh yeah that relative risk of seventeen percent. That doesn't tell me anything. Yeah I wish I could give you a good answer about one. This is going to happen because the cynical party says it will never have. I mean there's a reason that every advertisement that you see that every doctor trying to get you to do something and then every news story. C is always going to cite the relative risk. Because it's always going to be bigger and journalists and media people want clicks. They want views. They want people to read. And telling you that something is going to raise or lower by and large amount is always going to get more attention than that's really really really small and so almost every single story you will ever read. That seems to you to be frightening is going to be a relative risk now of course if you read the articles I write. I laser focused on the absolute risk. And I make this point over and over and over again because this is almost my biggest pet peeve but if there's a disease out there and it has a fifty percent chance of killing you and I reduce it to a twenty five percent chance of killing you with the pill. That's a fifty percent reduction in risky. But that's massive. I mean I dropped you from you know to win four to a one in four chance of dying. That's huge but if the risk of something killing you was point. Oh five percent and I reduced it two point. Oh two five percent that is also a fifty percent reduction but but affects almost nobody tens if not hundreds of thousands of people would have to take the bill before they would see a benefit and of course what we call them. Go ahead. Well I was GONNA say the latter scenario is more common. Oh yes I was GONNA say. Almost every drug you've ever taken is much more like the ladder. There's a there's a statistical the number needed treat. Basically you figure that out by taking a hundred and dividing it by the absolute risk reduction like how much absolutely risk doubt so in the first scenario if we went from fifty to twenty five percent. That's a twenty five risk reduction. One hundred divided by twenty five is four that means for every four people to take the pill one's going to get a benefit. That's amazing. Almost. Nothing in medicine works that way on the other hand. If the absolute risk reduction is let's say point one percent then creates a thousand thousand people have to take the pill for one person to see benefit and nine hundred ninety nine will not. That's almost everything we do in medicine. It's certainly almost everything we do. With respect to food and so we're asking thousands of people to change their diets forever knowing that maybe what may see a benefit and that all the others will not eat perfectly rational unreasonable for lots of people to say? I don't want to do it. It's just not worth I'd rather live. You know the way that I want to live unless the risk is really high now of course if the risk is really high if they're in a high risk group it's GonNa make a huge difference then of course it makes sense you know people have sealant. Disease should not eat gluten. We're not talking about a tiny absolutely risk reduction. We're talking about a massive risk reduction and that's real but for most healthy people reduce includes GonNa make almost no difference whatsoever and so therefore there's really not much reason to do it out decker. Cara one of the one of our favorite examples of absolute versus relative risk. Reduction comes out of an advertisement for I think it was for Zocor. No lipitor for lipitor. Okay and so this advertisement which I'm sure you have seen said you know. Thirty percent. Risk Reduction thirty six percent. Risk reduction sounded like a lot and what it came down to is over the course of five years. In the Placebo Group. Three people had a heart attack and in the Lipitor Group. Two people had a heart attack over the course of five years and that was thirty percent. Thirty three percent risk reduction it. It doesn't make lot sense does it. Well what if there were ten people in the study but there were thousands of and that's the point. It's really the absolute risk of matters. It'd go from thirty percents to twenty percents or did it go from you know point. Oh three percent two point. Oh Oh two percent those really really really different things but of course the news and the Drug Company everyone else is. GonNa call it. Oh an absolute relative risk reduction of about a third and that's it it's it can scare people who are people to put the behavior change but it's not an accurate representation representation of your individual benefit now. Well we're on the topic of cholesterol. A lot of people have been told and understand that. It's a bad thing to eat. Foods that are high in cholesterol. So so it's important. It's important to understand that you know the vast majority of the cholesterol in your body is actually made by your liver. Because of course cholesterol has a function. It helps moving things around in your body and so still people thought while people that eat a lot of cholesterol are going to have high cholesterol and they did some studies. They were observational in nature. That showed that perhaps people that it a lot of cholesterol had more associated with high slightly higher levels on the whole of cholesterol but then finally they got around to some randomized controlled trials and the actually also got around to doing some better research with the observational Peter. And they took people even people say with diabetes and they randomized them to. Hey you eat a couple eggs every day for months and you eat no for a month and then we'll check your cholesterol and then have you your diet and we'll wait another month. We'll check it again. And they found for the vast vast vast majority of people didn't matter that the cholesterol level was being produced by the body had nothing to do with how much cholesterol they were. Actually consuming and these studies are not new. A lot of them have been you know decades old and still it took until I think it was the two thousand fifteen guidelines for the. Usda to finally changed their tune and catch up with the science and say you know what we eating. Cholesterol is not that big a deal. It's there are lots of other things that are related to it. Some people think saturated fat might be related to it but actual cholesterol. The idea of eating eggs is not what drives you to have high cholesterol. But it's amazing that they still hasn't permeated people's consciousness. I can't tell you how many people are still looking trying to go to F beaters or two to other egg substitutes or eating eggs omelets which are a crime against nature and in order to try to reduce their their cholesterol. It just doesn't work. Ironically enough. I wrote about this a couple of years. I mean I think it was one of my first article in the New York. Times editor rose because my daughter loved eggs and really wanted their bags breakfast every day and my wife because the nurse practitioner was really against it and we were sort of like not arguing out of participating. Because I'm not sure this is a problem and that was really when I started digging into literature on that in our first book that I wrote on the certainly written a bunch of papers on it but and everyone is finally caught up. And now you know my daughter and my waste have eggs for breakfast most weekdays which also makes the dog. Rahab because he loves the scrambled eggs. But you know it took this kind of change even in my own household to to get even my own family members to understand that this. There's just no evidence for this. There just isn't an in fact there's evidence against it that that consuming cholesterol for most people doesn't make a big difference in even for the people that does it's an incredibly tiny absolute difference. Well you know Dr Carol. Even when a massive study comes out you know like the one in the annals of internal medicine about meat or even when studies come out and they go you know that saturated fat problem that everybody's been worried about for decades it it. It may not be as bad as we all think. Even when there's data people's behavior doesn't change much so once. The study has disappeared without a trace. Once it's out of the headlines once your article has sort of disappeared into the the Great Internet people are still told no more meat avoid saturated fat watch out for cholesterol. It's GonNa give you a heart attack and for sure. Don't eat any salt that too. Yeah I well. Here's the thing I would say. There's there's both pessimism and optimism here. I think the pessimism comes from the fact that like we have not stopped having these arguments and we will continue to have these arguments. The optimism is. I don't think most people are listening. you'd have to live under a rock not know to know that lots of people think that eating meat is bad for you and most Americans I think have just stopped listening And the same thing I think is going to happen with salt. It's things are going to have with a variety of things because we continue in the sort of academic world to continue to argue about these things and then get upset when people refuse to listen. I'd argue that people are sort of acting rationally. They're hearing that. There's not certainty they're hearing that you know. Even if there's some relative risk reduction of population level that it for an individual it doesn't matter too much. They're hearing that you know. Everybody should change their behavior. But we're not necessarily sure if there's confounding so I don't know they might be acting rationally now. People who think this stuff is terrible for you. We'll tell you I'm doing everyone a disservice and that you know the fact that people aren't listening is a bad thing. I'm going to come down on the I think. In this case there's not nearly certainty or the absolute risk that that so many believe and therefore. It's quite rational that the people aren't listening. There's another area where people are really at the mercy of their health professionals in particular. They're cardiologists and in extra particular. Their interventional cardiologists so changing gears. Here for just a SEC. There has been a ongoing controversy for decades about the value of angioplasty and a stent in patients that have something called stable angina. And I'll let you tell our listeners. What that means. Because for years an interventional cardiologists would squirts some die into a catheter. That would go into the heart. And there'd be some blockage in coronary artery and the person had no symptoms and so the person has told your heart attack waiting to happen. You need a stent and you need it like yesterday and so a lot of stance. A lot of angioplasties have been done and a lot of Bypass surgery have been done over the last two or three decades to quote unquote prevent a heart attack. Well there was a study that kind of undermined that thinking and it was. You know a lot of controversy. A lot of cardiologists push back but then not long ago came another study the Big Kahuna of studies and once again it said You know medications and lifestyle changes are justice effective at preventing a heart attack or prolonging your life as having a stint place. So can you put this all into perspective? And how a patient who has told? You're a heart attack. Waiting to happen is supposed to react well. Part of the problem is that we recognize when it comes to medications entered the food and a lot of interventions that the placebo effect is a big deal that if people believe they're being treated that can have a massive effect on on their outcomes With respect to procedures. We rarely care or do that. Because we we just assume procedures work if we see a benefit. How could it be placebo effect? Nobody can will away a heart attack and so it or will away heart pain that can't happen and extending must work so the big study. That happened a couple of years. Ago was an actual randomized controlled trial where they had strict criteria for who who met stable angina and then they randomized them so half of them they basically threaded the catheter. All the way up there and then put in a stent and for half of them. They threatened the catheter. All up there and then did nothing. And they didn't tell the cardiologist and they didn't tell the patient whether or not they got stints and then they check them out weeks later and they couldn't tell which ones have the spencer not because they look they had the exact same outcome. That's horrifying because it means that the placebo effect is real. Even with respect to this the benefits people were seeing. Were not related to the stand. They were just chance or or placebo effect. And it's real now. Of course cardiologists. Were very angry about this because we put a lot of stents and they argued against the study about well the sense that I use only for sick patients and this and that but we know that lots of people are getting stamped to meet criteria for not doing and the more recent study confirmed. I mean again. We've seen that for some of these that that when we actually do placebo controlled randomized controlled trials that the benefits are not nearly as drastic as people think and. I don't want to just pick on cardiologists. This happens for lots procedures. My favorite one was in the early two thousands arthroscopic surgery for osteoarthritis of the knee was like the most common procedure done in the United States. And then they finally randomized controlled trial where they gave one third of the people arthroscopic surgery and one third of the people got. La's which is basically just wash out your neighbor sailing and one third of the people. They they made an incision twiddle their thumbs for twenty minutes sewed it up and told them they had arthroscopic surgery. And they all say outcomes today arthroscopic surgeries much less comet gluing for for deebo plastic for for certain fractures of the Vertebra a lot of these. When they finally put them down to randomized controlled trials. It turns out the procedures performed no better than a sham procedure or or just placebo effect and again are fine but we don't do really unfortunately well designed clinical trials for too many things and we just assume this stuff works and we assume it makes a big difference and then years later we find out we were wrong. Dr Carol we are almost out of time. What message should our listeners. Take Home Today. I think that the best one is that it's totally reasonable to first of all ask your physician when they're prescribing a recommending. Something to you about. What's what's the wheel. Absolute effect I. Can you know that I should expect to see from this? The second I think that too often we only look at one side. We look at the benefits or we look at the harms not both sides of the story and with all of these. There are potential. Harm their potential downsides of making these changes even if those are joy and those should be measured against the absolute benefit. You might see or the absolute harm reduction. You might see from making a change or undergoing a procedure. And you've got to think about both Dr Aaron Carol. Thank you so much for talking with us on the People's pharmacy today anytime you've been listening to Dr Aaron Carroll Professor of Pediatrics and Associate Dean for Research Mentoring at Indiana University School of Medicine. He's also director of the Center for Pediatric and Adolescent Comparative Effectiveness Research. He has co authored three popular books. Debunking medical myths has a popular. Youtube show called healthcare triage and is a regular contributor to the New York. Times the upshot Dr Carols. Most recent book is the Bad Food Bible. How and why to eat centrally. After the break we'll talk with Dr Joann. Manson about the clinical trial. She led called vital. What questions were the scientists trying to answer? A randomized control. Trial like vital is considered a scientific gold standard. They examined both vitamin D. N. Fish Oil. What helped and how much what didn't help at all. You're listening to the People's pharmacy with Joe and Terry Graydon. This people's pharmacy podcast is brought to you in part by Verizon A- dot Com verizon lab offers home health tests that allow you to monitor your hormones and health conditions you can take control of the quantitative assessment of your health and learn about male and female hormone balance the stress Hormone Cortisol Leaky Gut. Gluten intolerance or your gut microbiome take a more active role in tracking your health and take twenty percent off your first order of a male intesting opportunity with the Discount Code People that's P. E. O. P. L. E. All upper case to learn more go to verizon dot com that's V. E. R. I S. A. N. A. DOT COM Welcome back to the People's pharmacy. I'm Terry Graydon. And I'm co Graydon. The People's pharmacy is brought to you. In part by COCO via offering plant based nutrients in the form of COQ. Au flavonoids for brain and heart health online at Koko via DOT COM and by Kaya -biotics probiotic products made in Germany from certified organic ingredients Ky. -biotics dot com. Many people. Think there's no science support. The use of supplements our next guest has been conducting well controlled large studies to examine that precise question. Doctor Joann. Manson is chief of the division of Preventive Medicine at Brigham and Women's Hospital. She's also professor of medicine and the Michael and Lee Bell Professor of Women's Health at Harvard Medical School Dr. Manson is the principal investigator of the vital trial. Welcome back to the People's pharmacy. Doctor Joann Manson great to be here. Thank you Dr. Manson. You are the principal investigator for the vital trial. Would you tell US briefly? What you and your colleagues were hoping to discover in this trial in how you went about it. So the Vitamin D. Omega three trial vital is now a completed a randomized clinical trial in more than twenty five thousand men and women nationwide in the United States looking at the effects of vitamin D supplements at a dose of two thousand. And I use a day and also omega. Three FATTY ACIDS EPA DHA fish oil at a dose of one gram -Oday in the prevention of cancer and cardiovascular disease where we were able to look at the independent of each of these supplements and we could look separately at vitamin D separately. It'll make us reason as well as their affects in combination and we treated the participants. They were the double blinded trial. They were taking study pills from a blister. Pack a calendar pack and the intervention went on for a little over five years and we recently published the findings and What we saw were some promising signals but overall no really clear cut Benefits of the Vitamin D. Or The Omega. Three fatty acids in preventing cancer or cardiovascular disease but what we Where we did see the promising signals were for the Omega threes. There was a suggestion that those who had low fish consumption at baseline those who came in eating less than the average amount of fish which was one and a half servings per week they did have a significant reduction in the primary endpoint of major cardiovascular events. Heart attacks strokes. Cd death and in the overall Trial we did. See a significant reduction in heart attack with the Omega threes. About Twenty eight percent reduction for Vitamin D. We saw a signal promising signal for reduction in cancer death that once we accounted for cancer. Latency that we we looked at those who had been in the trial for. Let's say two years. There was a statistically significant reduction in cancer death But we did not see a significant reduction in the primary cancer and point of Total invasive cancer so the results are complex but I would say both of the interventions voces supplements had promising signals. That we WANNA follow longer. We want to see if over time the benefits become more clear-cut or whether over time these benefits just appear to Should go away so long. Term Followup up is needed and At this at this point we're certainly not recommending that everyone in the world begin taking vitamin D. or Omega threes but but actually There are some subgroups who may benefit Those who have low fishing take may WANNA talk with their healthcare provider about taking a n Omega three supplements vegetarian. Their algae-based forms of the Omega threes of the fish oil or EPA DHA and for Vitamin D. It's the signals. Were promising. There were no adverse effects. And so we're saying if you're already taking in two thousand and I use a day. There's an urgent need to stop based on the results of this trial. Manson please explain why this kind of research is so crucial to making determinations about what people should do what we call our. Ct's randomized control trials the gold standard and this is kind of the platinum standard because it went so long and it was so well controlled That compared to what we would perhaps referred to as epidemiological studies where we look at populations and they tell us what they're eating or what they're not eating so tell us the significance of this research. Place boy it is very important to have random association. The process of random station which is like flipping a coin. Everyone who enrolls in the trial is randomized either. The active or the placebo group by the computer. It's totally random. Ki- you know flip of a coin process. This ends up balancing out all the other risk factors for the point of interest especially in a trial. This large twenty five thousand plus we were able to have very similar distributions of cigarette. Smoking physical activity dietary factors. A history of high blood pressure diabetes cholesterol all of these variables balanced out between the active treatment group and the Placebo Group. Therefore any result that we saw we can feel reasonably confident especially for the primary and pre specified secondary endpoint due to the treatment itself and not to other factors when you're looking at people who choose to take supplements who who take for example a vitamin D supplement or fish oil supplement. Sometimes are there other factors? That can what we call confound the associations so people who take supplements maybe more health conscious they may be more likely to exercise or to follow a healthy diet or to be more compliant with medications that had prescribed for them such as high blood pressure treatments or statins for High Cholesterol. Other medications for high cholesterol. So sometimes you see a lower risk in those who are taking supplements but it's not a cause and effect relationship. We often say in epidemiology that correlation does not prove causation. There could be a lower risk correlated with Taking the supplements but the lower risk maybe due to other factors such as a people who take these supplements are more physically active but doing a randomized controlled. Trial takes care of that. I care of it. Took care of virtually all of those factors if the trial is large enough. Everything looks very similar in terms of other Factors risk factors lifestyle behaviors. They get balanced out by the randoms. Ation Process Dr Manson. I think a lot of people are confused about supplements because there have been a number of articles written in the last several years by health professionals. Who Say oh. Don't waste your money. It's just GonNa be expensive urine. These dietary supplements these vitamins. These minerals. They don't do anything or even fish oil or even fish oil for that matter. There've been studies that say is pretty much worthless and now we have this study which suggests that actually might in higher risk patients or people who aren't eating fish that they might see a reduction in heart attacks for example if we look back at one of those early Staten Studies involving lipitor used to be advertised that it lowered the risk of heart attack by around thirty to thirty three percent so relative risk reduction. Not that different from what you found yes for for heart attack itself. The results were quite similar to what scene with the staten? The overall for total cardiovascular events heart disease strokes ebd death the results have been more impressive for statins. However there's also some evidence from a what we call a. Meta analysis we just published a combination combining all of the different randomized trials. That have been done of the Omega threes and looked at whether there is a dose response relationship that there's a greater benefit in those who take the higher doses and there does appear to be a dose response so we're now interested in testing higher doses of the Omega threes which may confer greater risk reduction for both heart disease and stroke the dose that we tested did not have benefits for stroke but did have show a reduction. In the Coronary Heart Disease Outcomes now Dr Manson we we're looking today also the question of guidelines and how guidelines may be guided in fact by research and. I'm wondering if you have any thoughts about how the vital trial might contribute to guidelines about what we all should be doing. Well I seek that guidelines really need to start taking into account subgroups of the population who may benefit more than others very often especially in primary prevention the guidelines have been much broader. You know in general for the total population. Don't take this or do take that and very very few treatments are Preventive Mo. Modalities will ever pass that test that they will be of benefit to everyone in the population. Very very broadly. But I see that. The various experts and clinicians researchers looking closely at the vital findings will see that there is a clear signal that those who have low fish consumption had a reduction in their cardiovascular events in their heart disease events looked at separately and those who started out with higher intake did not and that guidelines could include recommendation specifically for people who have higher or lower intake of these nutrients from from the Diet. I think that that would be an important step forward We'll have to see if the guidelines will be modified but I think that there may also be an interest in seeing other trials of for example the Omega Three for CD Reduction. Because most of the earlier trials were in populations that already had heart disease already had a history of cardiovascular disease. Vital was one of the very first trials to look at primary prevention people who already have a clinical cardiovascular event to see if Omega three supplements could prevent a first heart attack or I cardiovascular event so perhaps with an additional trial showing benefits of Omega threes maybe even greater benefits with a height with higher doses. And also this dose response in terms of if you start out with low intake of fish low intake of Omega threes. You may be more likely to benefit that could be enough to really influence the guidelines for only three supplementation and for Vitamin D. It's unlikely that there will be a change. A major change in the guidelines at this point because overall the results of the Vitamin D supplementation. Trials suggest that what has already been recommended by the Institute of Medicine now known as the National Academy of Medicine of six hundred to eight hundred. I use a day. Vitamin D That does seem to be enough for a bone health. Higher Doses have not clearly shown greater benefits and so far there isn't compelling evidence that higher doses will reduce cardiovascular disease or total cancer. There is a promising signal there for cancer deaths that needs to be explored further. I think there are a number of studies that can be done to delve more deeply into those findings but I don't think it will at this point. Lead to a change in the amount of vitamin D recommended. Said we did see safety of safety of today. Yeah I I'd like to pursue very briefly because we only have a minute or two left Dr Manson and that is the vitamin D. What I call it the anomaly. There's a lot of data to suggest that people who are low in Vitamin D. Perhaps because of where they live because perhaps they also use sunscreen religiously and so if they're naturally low in Vitamin D. There are a lot of consequences we we've seen epidemiological studies suggesting high blood pressure and arthritis and cancer. We down a long list of things that have been attributed to low vitamin D but unfortunately a lot of the clinical trials the randomized controlled. Trials have not shown dramatic benefits from supplementation. Why do you think that is well? I the low vitamin D disease. Associations are found. It's usually based on a blood marker for low vitamin D. And so it's you you. You can't be sure it's a cause and effect relationship so so people who have a low blood level of vitamin D do tend to have less time outdoors. They may be less physically active. They may have a less healthy diet. They may have underlying disease that interferes with Vitamin D. SYNTHESIS. It could be a marker for poor health. It's not necessarily cause and effect relationship that said we do know that's tremendously important to avoid vitamin D deficiency and. That's why for everyone. It's recommended to get at least six hundred to eight. Hundred is a day and if it can't be achieved from diet if people are not having for example fortified dairy products of the not having fish which can be high in vitamin A. or Mushrooms are foods that are that are sources of Vitamin D. Then they should take a supplement and I generally think one thousand to two thousand is a day is very reasonable. We documented safety over five years with two thousand. I use a day so if anyone has any concerns about whether they're getting enough from diet or having the foods that contain vitamin D. It's very reasonable to take a low to moderate dose supplement but avoid mega dosing because mega dosing. Getting above. Five thousand. Ten thousand. I use a day unless your clinician is recommending that specifically can be harmful doctor Joann. Manson thank you so much for talking with us on the People's pharmacy today. Thank you great thing here. You've been listening to Doctor Joann Manson. She's chief of the Division of Preventive Medicine at Brigham and Women's Hospital. She's also professor of medicine and the Michael and Lee Bell Professor of Women's Health at Harvard Medical School Dr. Manson is the principal investigator of the vital trial. We spoke earlier with Dr Aaron Carroll. He's professor of Pediatrics. And Associate Dean for Research Mentoring at Indiana University School of Medicine. He's also director of their center for Pediatric and Adolescent Comparative Effectiveness Research. Dr Carol Has Co authored. Three popular books debunking medical myths. He has a popular youtube show called healthcare triage and he's a regular contributor to the New York. Times the upshot his most recent book is the Bad Food Bible. How and why to eat simply Lynne Segal produced? Today's show our Dr Ski engineered Dave Graydon At. It's our interviews. People's pharmacy is produced at the studios of North Carolina Public Radio W. UNC. The People's pharmacy theme. Music is by J. Liederman. The People's pharmacy is brought to you in part by Verizon Analytical Laboratory providing home help test for hormones gut health and the microbiome online at V. E. R. I S. A. N. A. Dot Com and by Coco via maker of High Potency. Cocoa Flannel supplements that support cognitive and cardiovascular health more information that cocoa via dot com if you would like to purchase a CD of today's show or any other people's pharmacy broadcast. You can call eight hundred seven three two two three three four. Today's show is number one thousand two hundred. You can also find it online people's privacy dot com. When you visit our site you can share your thoughts about today's show. Have you found changes in nutritional guidelines confusing? Tell us about it at people's Pharmacy Dot Com. You can also sign up for free online newsletter or subscribe to the free podcast of the show. Never Miss Another episode in Durham North Carolina. I'm Joe Great and I'm Terry Haden. Thanks for listening. Please join us again next week. Thank you for listening to the People's pharmacy. Podcast it's an honor and a pleasure to bring you our award winning program weekend and week out but producing and distributing. This show is a free. Podcast takes time and costs money if you like what we do and you'd like to help us. Continue to produce high quality independent healthcare journalism pleaseconsider chipping in even a small donation can make a big difference. All you have to do is go to people spermicide dot com slash. Donate whether it's just one time or a monthly donation. You can be part of the team that makes the show possible. Thank you for your continued loyalty and support.

Doctor Joann Manson Dr Aaron Carol Terry Graydon Joe Graydon Dr Aaron Carroll Pediatric and Adolescent Compa Professor of Pediatrics and As Joe Graydon Terry Graydon cardiovascular disease New York Times Indiana University School of M cancer Doctor Joann verizon director United States New York annals of internal medicine
Ask The Doctors: Listener Questions On Coronavirus, Children

Radio Boston

16:16 min | 2 months ago

Ask The Doctors: Listener Questions On Coronavirus, Children

"We thought kids were relatively safe. New data out this week from the American Academy of Pediatrics and the Children's Hospital Association however founded almost one hundred thousand children in the US tested positive for the corona. Virus. In the last two weeks of July alone. So what are we actually know what is the impact of Covid nineteen and the coronavirus on kids and what does that mean for Massachusetts cities and towns that are currently trying to figure out how to reopen schools next month for the rest of the hour let's ask the doctors call with your corona virus and Children questions and your other coronavirus questions to we're at one, eight, hundred, four, two, three, eight, two, five, five, that's eight hundred four to three talk joining us for this conversation is Dr Rick Molly Senior Physician in pediatrics at the division. Of Infectious Diseases at Boston Children's Hospital and a professor of Pediatrics at Harvard Medical. School Dr, Mollie welcome back to Radio Boston. For having me. And also joining us is Dr Laura Vinson Guzman a general excuse me a general pediatrician that's hard to say associate medical director of the Pediatric Complex Care Program Floating Hospital for children at Tufts Medical Center Dr, Arvidsson Guzman Welcome to Radio Boston and you for having me. All right. So let's start with something that president trump said last night at a White House, Corona virus briefing discussing the impact of the virus on children. We're GONNA have sound for you just injustice second. In what the president is saying here, I think we'll just skip the sound and I'll summarize it. He says I think for the most part kids do very well, they don't get very sick they don't catch it easily. And he says that they don't transport it to other people not very easily. So let me start by asking the two of you is that the case and what do you make? Of the transmission numbers, we've just heard from those last two weeks, of July, given that claim. Or why don't you start? So fortunately, we've been very lucky for the majority of children. Cases have been very mild This is always excellent. We don't want our children to be sick, but it presents a major public health problem because many of our children have you or no symptoms, they don't necessarily come to medical attention on, but they are at risk of spreading the virus others and this makes it a challenge especially when we think about reopening schools that children may serve as doctors and bring the virus home to other family members or household members who are at high risk. So, Dr Mollie. Let me follow up with you then because the president also mentioned in his briefing that the mortality rate for children who get the virus is quote a tiny tiny fraction of death and quote and that children are quote essentially immune and quote I just want to find out. Do those statements follow the? Science. Well in general I think it's important to. Focus more on the data and and less on some political statement. So I will just summarize it by saying that children are absolutely not immune to the virus. It's the the you quoted. To Santa are exactly indicative of that children can get infected and we also know both from our work at Boston Children's at Tufts Medical Center in everywhere across the country that even if children are less likely to get sick from this virus, the laws of large numbers suggest that once you start having a lot of kids getting this virus, you're going to have some children who get very severely ill some of them unfortunately might even die and it is not helpful to think of it as children being a completely safe from this. Because we know that unfortunately as the virus continues at spread, some children will suffer gravely from the consequences of infection. Okay. So one more baseline question there before we go to the phones I I hear you. I am confused about this from studying for this today. So I WANNA ask it does appear from the data. However, that children are at least less likely to get the most severe forms of the disease. Is that correct Dr Insane Guzman? That is correct on overall for some reason, children seem to do much better than their older counterparts typically with respiratory illnesses were used to seeing both the very young and the very old suffering about. In this virus seems to be a little unique in that respect. However, there have been cases as you may have read about yours may have read about I'm about the multi-system inflammatory syndrome that has been seen in children on, and some of these cases have been quite severe and resulted in unfortunately does of some those affected. And actually what we know about that syndrome I mean it's this terrifying thing that's looming out there. What do we know? Dr Mollie do we have you? Yes I'm sorry I was disconnected for a second. Great. So were you able to hear my question or would you like me to repeat it? Please repeated sorry this this syndrome, this syndrome that we're seeing among very young children. That Dr Arvidsson. Guzman was just talking about it seems scary and also kind of. Hard to get our hands around, what do we actually know about it? Well. You're absolutely right. It's a very scary syndrome it is rare but when it happens, it can be devastating to the child and it can induce all sorts of complications including cardiac complications or heart problems. For example, what we think is happening with this syndrome and again six months ago didn't even know that this syndrome would even exist. So A. Lot of these data are preliminary. What we think is happening is that children for some reason who are exactly as Davidson Guzman said less likely to get very sick from covid nineteen seemed to have a delayed immune reaction to the virus such that somewhere around a month after the peak disease in any city in the US for example, on the East Coast. That, we've seen we start seeing these kids show up with this very unusual syndrome while there's no more detectable virus in them or if it's there, it's at very, very low amounts and what we do see is that they have an antibody response to this virus, which suggests that they saw this virus maybe a month ago and that it took them about. A month to develop an inflammatory response that is very dangerous and damaging to their body. It's rare. But when it happens, it's very scary. It's very dangerous and unfortunately as the numbers of cases in children increase as the report you mentioned indicates, we can expect an unfortunately fear that we're going to see a lot more of these cases in the coming weeks. I. WanNa. Turn to the phones here one, eight, hundred, four, two, three, eight, two, five, five that's one eight hundred four to three talk to ask your question about corona. Virus and kids. We've got Devon on the line from Gloucester Devon go ahead. Hi there I'm a mother of two and my biggest question in regards to getting the disease is, what is the hospitalization rate looking like? Now, the cases for children have increased what kind of hospitalizations rate can we expect if that continues to be the theme? Okay Great Question Devon. Dr Arvidsson Guzman. Is that something you can answer for us I would probably defer to Dr o'malley who may have were up to the information on that. Oh. Sure. So from the report that we saw, which was again from the American Academy of Pediatrics, very recently, which looked at twenty states and also New York City they didn't have all the data from New York but they mostly had data from New York City showed that. About somewhere between one to eight percent of cases of covid nine, thousand, nine, hundred, and a child resulted in hospitalization. So it's a wide range unfortunately would which reflects the fact that these data were collected in different states using different criteria but that number of somewhere around one to ten percent of hospitalization when a child actually comes down with. Kobe nineteen. Is is a ballpark. Importantly. The. Greatest number of those children did not were able to be discharged and recovered from the infection, but it still is, of course, very scary and very disturbing for any family in a child to have to be hospitalized for an illness like this one. One to ten percent is a huge swing. Do you think we'll be able to narrow that down to a nearer band of sort of certainty or what we know over time or is it really just that variable? It's a great question I think that once you start looking at other factors, some of which Dr Arvidsson Guzman is an expert in for example, in in complex care of children with multiple co morbidity, you will probably start seeing that in healthy children, for example, who have no. Potential risk factors. The number is going to be much closer to the one percent that I mentioned or even less, but unfortunately as of now. We have to sort of take into account. The possibility that some of these children have other complications, other important medical needs, and when you add that to Kobe nineteen, that might mean that the safest thing to do for the child is to be hospitalized. Dr Arvidsson Guzman before I go back to the phones. Is there anything you'd like to add to that? I'm yes. I would say certainly children who have underlying medical conditions are at higher risk of for more severe complications related to Covid Nineteen I would say that's fair to say in my patients as well. Those I've seen who are hospitalized generally have underlying conditions may be on respiratory support at home on May have required additional support that landed them in the hospital virginal care. When eight, hundred, four, two, three, eight, two, five, five, that's eight hundred four to three talk to ask your question about the coronavirus to our doctors. Today, we've got denise on the Line Medford Denise go head. Hi, thanks for taking my call. My question is this children under the age of one likelihood of contracting, Colvin and other any differences for those infants that have been breath at. Dr Arvidsson Guzman. Let me come back to you on this one. Yes. I would say this is certainly an area where still learning quite a bit about in terms of infants, they certainly can be affected and generally from the data I've seen shows some of the similar symptoms in terms of respiratory being a primary symptom. In terms of being breastfed it's difficult to say we you know the benefits of breastfeeding in terms of the antibodies that mother may provide her child. However, if the mother has never been exposed covid nineteen herself before she may not necessarily have a protective antibody to provide to the child as for a mother who may contract covid nineteen while they are pregnant on, it still remains to be seen if there's any sort of. Ability for the mother to transmit some sort of protection through breastfeeding her child. Dr Mealy I. Want Hark back that I call from Gloucester who was calling about hospitalizations because there was research at at the end of the week from the CDC showing that children of color are much more likely to be hospitalized from corona virus than white children are let next children are eight times more likely black children are five times more likely to be hospitalized. Why is that the case? Do we know? I think it's fair to say that that we don't really know. This This Syndrome is disease has surprised most clinicians and epidemiologists more times than we can remember over the last six to seven months. But one of the things that has come out very clearly from every study that we have seen is that this is truly disease of social and economic disparity. So certainly, populations that are more vulnerable from an economic or social perspectives are at much greater risk for serious there at greater risk for getting the infection and also at greater risk forgetting severe complications from the disease. What is unfortunately so bring in this is that we hoped that that would not then trickled down to their children but unfortunately, the report you cite really does indicate that the social disparity and the risk factors really do extend across all ages. There are lots of possibilities. In hypotheses that people are evaluating for the An. Honestly, at this point I think it would be very. Imprudent to try to say which one is the most likely but I think it's very clear that when you have populations. That are socially and economically disadvantaged the risk to their children as well as to the adults is greatly magnified. Dr, Arvidsson. Guzman the the big question right now about kids in the corona virus is schools. What do you tell your patients when they ask about sending their kids back to in-person schooling? Any kind this fall It's such a difficult decision and I think it really is a very personal decision as well on considering the needs of the Child on terms of their education. Considering who else is in the household is. WHO might potentially high risk in for some students in particular who are receiving Special Education Services on it becomes an even bigger discussion although our special education teachers are fantastic. Some of the students rely on equipment and adaptive technologies that simply can't be translated through the ritual setting. Unfortunately, some of these children are also have other medical co morbidity is that put them at even higher risk of complications if it were to contract covid nineteen So it's it's a big balancing act between educational needs focus on social emotional halt these children as well as balancing safety of the child, the family and the teachers and administrators at the school. Dr Mollie, we talked to the Superintendent of schools in Chelsea yesterday her cities at almost five percent positive test rate which led her to determine that she's not comfortable offering any in person education at the start of the year. Is there a positive test rate that would be appropriate to reopen schools? It's a very good question. I think what I encourage people to do is to look at the trajectory of their positive or negative rates of of testing in other words. If you start seeing that the numbers are creeping up to to go the opposite direction under question if you see a community where it's one percent, two percent three percent and keeps on rising and the behavior of the population is not changing there's no new restrictions as no changes in behavior, it just doesn't Doesn't take a mathematical model or to tell you that the number is gonNA keep on increasing and some measures probably need to be taken or the school will need to be a shutdown conversely to get to your question once you start seeing that measures are being taken that for example, the areas that we believe are representing hotspots of transmission that those areas are being closed down. For example, that certain activities are being reduced and the numbers start decreasing below that five percent positivity that you site. Then I think consideration of reopening wisely and carefully could be entertained. And I'm going to have to terrible run out of show that Dr Rick, Molly of the Harvard Medical School Dr Laura Arvidsson Guzman of the floating hospital for children at Tufts Medical Center. Thanks to both of you.

Dr Laura Vinson Guzman Dr Mollie Covid Tufts Medical Center Boston Children's Hospital Arvidsson Guzman Dr Laura Arvidsson Guzman corona American Academy of Pediatrics Dr Arvidsson president Children's Hospital Associatio Boston Children US Dr Rick Molly Boston Massachusetts professor of Pediatrics Dr o'malley Guzman
Show 1206: Live Coronavirus Update to Answer Your Questions

People's Pharmacy

1:05:23 hr | 7 months ago

Show 1206: Live Coronavirus Update to Answer Your Questions

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Virus infections are overwhelming hospitals in many parts of the US and around the world. What do you need to know? This is the people's pharmacy with Terry. And Joe Graydon off there's so much uncertainty and anxiety around this pandemic. How can you make informed decisions about your health? What questions do you have about Cova? Nineteen our guest today as an expert in infectious diseases and epidemiology. Dr David Weber is standing by to answer your email questions. You can reach us now at radio at People's pharmacy DOT COM coming up on the People's pharmacy answers to your questions about the cove. Nineteen pandemic send them to radio at People's Pharmacy Dot com welcome to the People's pharmacy. I'm Terry Graydon. I'm a medical anthropologist and I'm Joe Graydon I'm a pharmacologist today we're offering you a live corona virus update. We've asked our guest to answer your questions over his telephone to minimize the number of people in our w UNC studio and keep everyone as safe as possible. Our technical assistant is not present so we will be taking your questions by email. Address is radio at People's Pharmacy Dot Com our guest. Today is Dr David Weber. He's professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina. School of Medicine. He's also professor of epidemiology at the killing school of Global Public Health and medical director of UNC hospitals departments of hospital epidemiology infection prevention. Dr Webber is Associate Chief Medical Officer of UNC healthcare. Welcome back to the People's firms. He Dr Webber. Thank you so much for joining us. Thank you. It's a great pleasure to be here to talk to you about how people can best managed through this pandemic Dr Webber. We want to thank all of the hard work that you have been doing at UNC to get prepared for this pandemic and we want to thank all of the healthcare providers and first responders who are taking the brunt of this Extreme situation Dr Webber you were directly involved with. Unc's SARS response in two thousand three. Can you tell us a little bit about that experience and how it was different from what we're going through today? So SARS as the did co fit originated in bats if you mentioned in two thousand and three worldwide. They're about to eight thousand cases but through physical distancing and good public health. We eliminated that virus over a period of a number of months United States only had eight cases. Fortunately and I personally took care of the eight and last lab confirmed case of SARS but we learned a great deal about krona viruses that are applicable to our prevention of covert From that outbreak now Dr Webber. I wonder if you can give us an update on the statistics regarding Covert nineteen certainly Worldwide there are more than five hundred thousand cases and more than twenty five thousand deaths here in the United States. We have more than one hundred thousand cases with greater than fifteen hundred deaths. And as you know there have been particular hotspots such as New York Detroit. A rising hotspot A Washington based around the nursing home outbreak parts of California. Now there's something called a doubling time. Can you tell us what that means and what it is as of today the doubling time is the time of which the number of cases would double this rhythmic growth so for In the United States at the present time for coated it's on the range of three to four days which means that Three or four days from now they'll be two hundred thousand cases in the United States and at the end of a week from now they'll be roughly four hundred thousand cases in the United States. Unless we see this physical distancing beginning to decrease the rate of increase and. I assume that that actually is the point of physical. Distancing is to slow down the numbers of people who are getting sick all at once and indeed and that relates to how the disease is transmitted. We know if droplet contact the primary means of transmission meaning within six feet and direct touching To some extent there's indirect contact meaning. I rubbed my nose. I touch a DOORKNOB. The virus will survive on surfaces for hours. Today someone touches that and rub stare knows. That's probably less important than the Closeness so if people stay apart from each other then there really is no way for the virus to go from person to person after wherever there have been two events that have had a huge impact. I think there was a soccer game between Italy and Spain Terry and also of course Mardi Gras and it seems like those events where huge numbers of people were in close. Contact led to dramatic increases a week or two after the event. Yes absolutely so again. It's a closely transmitted disease. So if you put people in close proximity particularly long periods of time and we've seen this of course on cruise ships nursing homes the hotel outbreak in Boston. I suspect one of the reasons that we've seen so many cases in New York. Subways again people closely packed. So yes when you put people close together and you have susceptible people infected people then you get transmission Dr Weber. What's the nature of this novel Corona Virus? Why is it worse than influenza? So of course. There are several reasons that it's worth one of course is unlike influenza. Many of us have had influenza over the years and well. The virus mutates a little bit each year. We probably have some partial immunity. Here all of us are susceptible to this new corona virus which originated in bats and then spread to humans so none of us have any susceptible any resistance to it and just intrinsically. This virus seems to have a higher mortality and cause more complications than does stand influenza. Well when he comes to complications in particular. We've heard that older people are at the highest risk but the CDC just issued a report on confirmed cases sixty five percent of them were between twenty and sixty four years old and when we just look at hospitalized patients fifty five percent were between twenty and sixty four have we given younger people a false sense of security. We have You know this may be partly that older people have been more Physically distancing than younger people certainly the mortality older people it's much at certainly increases with other viral respiratory diseases like influenza. But it's much more apparent with this disease so certainly it may just be mixing issue. The other possibility is in nineteen eighteen. Nineteen the flu pandemic we did see more of what we call a w shaped curve with substantial amounts of morbidity and younger people which may have been due to their over Very vigorous immune response Right now I would say it's more likely we have more contact between the younger people then with older people. Thank you so much Dr Webber. We're GONNA start taking messages from our listeners. You can join the conversation. We are live radio at People's pharmacy. Dot Com is the e mail address. If you would like to email us questions for Dr Webber we do have one phone call sandy in wake forest North Carolina. Welcome to the People's pharmacy. You have a question for Dr Webber. Yes thank you Dr Webber. I have two questions. They are about paper items and food. we still get a paper newspaper and of course mail every day and I was wondering if the virus could be on these items and if so should we disinfect them before handling them and also just in the news in our town or near that a grocery store had an employee who was found to have the Corona Virus? So as far as shopping. In your opinion what's the safest way to get groceries to shop on our own wearing masks gloves or using a stores personal shopper? Kind of concerned like a lot of the store employees might be sick or having the virus. What do we do thank you thank you for the question? Dr Webber Two questions their newspapers and other paper items like mail and then of course shopping. Let me start with the shopping. Obviously with physical distance thing to the extent one can would like to say Six feet away from other individuals. I know many foods stores are staggering. The people coming in but certainly home delivery would reduce one's risk of coming into contact With Potentially infected persons and. I should say anyone who is sick. Meaning with fever or cough or respiratory symptoms should stay home and self quarantine themselves at home. Obviously they become more ill. They should call their Provider and not go out. Unless it's absolutely essential Dr Webber. Let me just interrupt there. And say that's even if they just think it's a cold right absolutely there's nothing clinically that allows us as physicians or patients to the separate. What could be flu and we still? I sing respiratory viruses like fluent RSV and cove. The symptoms are quite the same fever cough shortness of breath. I can start off with a sore throat What interesting symptom? We've not seen with other diseases loss of sense and smell which can be an early indication of disease and the disease progresses More symptoms but this could be exactly the similar to flu. Also things like muscle aches. Fatigue can occur as well now Dr Webber Sandy wanted to know about objects so she said if somebody in the supermarket has the virus and sneezes or coughs touches items and then they are brought to your house by. Let's say the the the supermarket through a delivery service. Does she have to worry about wiping. Down the surfaces of the OATMEAL or any of the other items and the same question was true with regard to her newspaper or her mail. Let me first start and say that this virus is not carried in foods. Food is perfectly safe and we not aware of any foodborne Spread of food in terms of surface. Items well this far as can survive. I'm not aware of outbreaks related to or transmission related to paper products Money bags and so on. It's survives a better at low temperature and low humidity and I'm more solid objects such as a medal and plastics So I'm not aware that those paper products really represent the risk. Obviously if one was particularly concerned than what you would do is take the food items out You and then perform good hand hygiene and discard the bag. Now we have of course heard from the New England Journal of Medicine that the virus can be found up to. What is it now about two or three hours in air in terms of airborne? That was an experiment. It wasn't real life and they also found that things like plastic and stainless steel. There could be signs up to three days. So caution of course is appropriate Absolutely let me say that. It's not surprising. It's in the air. It is a droplet spread disease. Meaning if I cough and you're within sixty you You can become infected but this study should not be interpreted as meaning this true airborne spread which has not been demonstrated meaning more than six feet and it does survive in the air for short periods of time this was a very artificial study where they injected virus into a drum and again. It's not surprising but this does not show long-term Sprint now. There is some good news in in this. We do need to take a break when we come back from the break. We're going to take more questions from our listeners. You can join the conversation via email Terry. The address radio at People's Pharmacy Dot Com. You're listening to the People's pharmacy with Joe and Terry Graydon. The People's pharmacy podcast is sponsored in part by Kaya -biotics K. A. Y. -biotics offers the first probiotics. Which are both certified organic end? Hypo allergenic I'll probiotics are produced in Germany. Under laboratory conditions with high quality ingredients and under strict regulatory oversight the three available formulas are created for very specific purposes such as strengthening the immune system fighting east infections and helping with weight loss to learn more about Kaya -biotics probiotics and the important topic of Gut. Health you can visit their website. Kaya -BIOTICS DOT COM that's K. A. Y. A. -biotics dot com. Use the discount code people for ten dollars off your first purchase. Welcome back to the People's pharmacy. I'm Joe Graydon and I'm Terry Graydon. The People's pharmacy is brought to you in part by Verizon A- An analytical laboratory providing home health tests for hormones gut health and the microbiome online at V. E. R. I S. A. Dot Com and by Coco via maker of high potency cocoa flannel supplements that support cognitive in cardiovascular health more information at Koko via dot com. Today we have an expert on the phone to give you a live corona virus update and answer your questions to practice appropriate physical distancing. We're taking your questions by email and that email is radio at people's pharmacy. Dot Com or guest is Dr David Weber. He is professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina. School of Medicine. He's also professor of epidemiology at the killing school of Global Public Health and medical director of UNC hospitals departments of hospital epidemiology. Dr Webber is Associate Chief Medical Officer of UNC healthcare. Dr Webber can people without symptoms actually. Spread the virus. So there's no question that individuals can be be symptomatic that has become infected without any symptoms. Now obviously those people by definition not coughing sneezing So their infectivity is probably much much less. And we don't actually know to what degree such people can transmit. It may occur but it's probably much less important than those who are more symptomatic and coughing detector Weber. Tom In Buffalo New York would like to know if you become infected at Let's say noon on a Monday. How long is it before you become infectious to others? And how long after that infection before you exhibit symptoms so we do know quite a bit about the timeline? We know the incubation period from infection symptoms can range. It's CL- as quickly as two days up to about fourteen days on average. It's about Seven days and we do know that people have a very high their highest viral loads and therefore they're most infectious when the symptoms. I begin we have a question from Alan in Dallas Texas. How does a person who tested positive no when they are no longer contagious and can safely be around others so the guidance from the Senate's for Disease Control? Is You are no longer contagious. After seven days from your onset of symptoms plus at least three days A symptomatic which they don't actually define no symtas but dramatically reduce cough no fever Off of any drugs that suppress fever like tylenol and feeling better. Now this is very similar. Question is from Jan. She says our granddaughters are now home from college. If they have self quarantined for fourteen days at home except for going to the grocery and walking outside. Is it safe to have them? Come into our home alternately. Could we meet in the backyard? We are seniors with lung problems so if they've had no symptoms in fourteen days and realizing there would be some very tiny risk that they would have acquired it while they were out shopping. The answer is yes they would be felt to be not have become infected and it would be safe to have contact again. Physical distancing Is Important in all cases and if one wanted to be absolutely sure certainly. Outside and physical distancing would eliminate even the slightest chance of infection. Dr Webber. I'm really glad that you use the term physical distancing instead of social distancing. Can you explain why you now using that term certainly because what protects you being six feet or more apart we want people to be socially interactive we want them to communicate on telephones by Snapchat By A COMPUTER. We want them to be supportive of each other. It's very hard and a very stressful time. Everyone we don't want people to social distance. What really is physical distance? Dr Webber we have an email question from Charlene in Orlando. She says my daughter was taken to the hospital. Two weeks ago with cove nineteen symptoms. She was not tested because she had no recent international travel she had been on a plane flying from or Landau to New Orleans to Philadelphia. And all of those places have confirmed cases through testing. The question is how long is the virus detectable so in people The virus can be detected using a nasal fringe swab. The way we do. A little thin swab goes to the back of through the nose to the back of the throat and viruses most detectable Through the PR test from the time of symptoms for about a week after that it often is undetectable in many people. The sicker you are the longer you generally have detectable virus. There's obviously there's been a lot of controversy about the tests because we were very slow to roll tests out Tom in Charlotte wants to know if the US could have used the W. H. O. Published Test Protocol. So I'm not specifically familiar with that the issue here for the testing. You're absolutely right. The tests have come online. I'm what slowly than we would like. And we even today have less testing ability than we would like and the major impact of that is the numbers we've talked about the greater than one hundred thousand maybe an undercount because of not testing the outpatients who have mild mild illness So that is the major impact of that. We so far have really had enough test to test. All the people generally who are sick enough to come into the hospital and require care. Lewis wants to know if a person recovers from Cova. Nineteen will he or she be completely or partially immune from reinfection and for how long so the best evidence suggests that in fact you would have a partial or complete protection for months to a two years with that based on Sars and mergers and I should say very importantly for those people There are now studies underway looking at convalescent serum for those who are twenty one days since proven illness taking their bodies which protected them and allow them to recover and then giving those two people who are now critically ill. Those studies are underway. That type of passive transfer of antibodies has been shown to work for other diseases. Such is Bola. Can someone transmit the virus after they recover a and you know? How long would they be? Contagious we keep getting that question. So again the virus drops off fairly rapidly and people who are recovering and as we've said Seven days since onset of symptoms and three days since the dramatic decrease of symptoms for the great majority of people. The virus will no longer be there. And you would no longer be contagious. The sick of people who are in the hospital and have severe pneumonia. They may have prolonged virus for Till they they get before they become a symptomatic. We're not aware in this disease that there's any chronic carrier state so once you've recovered Then you don't carry the virus for weeks or months like we would carry some other viruses. That's very good news. People have also asked if after you have recovered if you are then immune to catching it again. That's are certainly in the short term of that is Almost certainly The case we have a question from Sally and Ottawa County Michigan. She wants to know about physical distancing. How far away should people remain while passing others walking out side in a Wooded County Park for example. So ideally six feet. And if you're standing near so when you just read your arm out. They stretch here their arm out if your hands touch. You're probably too close but again the virus has to travel in the air and so Passing someone even if they were a little close to four feet. Outside with wind blowing would greatly diminish the risk than being indoors. And so it's a matter of how close you are how prolonged the contact is and then things like wind and other things that would disperse virus. Dr Webber. Do we have any idea why some people are more susceptible than others? And what I mean by that is we've been told that roughly eighty percent get over covert nineteen pretty quickly without too much in the way of discomfort or serious symptoms but that other twenty percent including a fair number of people who are relatively young in their twenties thirties and forties. Who Don't have some pre existing condition. Some of them have gotten really sick and some have died. What is it about their immune systems or about some other factors that we haven't figured out that. Make some people so vulnerable so we do know that Particularly age. The older you are particularly going up from age sixty makes you much more likely to develop your disease and unfortunately die. Particularly people over eighty other thing is with many other diseases underlying diseases. Such as diabetes cancer on chemotherapy and others make you at higher risk of having severe complications. But that's not to say that some young people in their teens twenties and thirties. It's just much less frequent for reasons. We don't understand can develop very severe disease and some of those unfortunately will die. Dr Webber William in Chapel Hill wants to know how to take care of yourself at home if you come down with symptoms and you're you know you're sick but you're not so sick that you need medical attention the question is should you. Should you take and saids? Should you take tylenol? Can you take both? What do you do for cough and what about asthma patients? So I let me say yes that we do believe people who have underlying lung disease such as asthma or chronic obstructive pulmonary disease will be more likely this is a respiratory infection to have more severe side effects in terms of taking care of yourself. There's no specific therapy That we know of. So it's a drink plenty of fluids. Rest as much as you can Some people have nausea and vomiting but that's uncommon so eat reasonably Certainly if you're having a high fever over one hundred and two and certainly reasonable to take Either tylenol or end sense if the tylenol or the end set itself isn't working. Stay within the recommended dose for your age or weight And you can alternate The two Medications they're over the counter. Cough medicines Certainly may help relieve the coffin. Decongestions may help there but most importantly if you're having trouble keeping fluids down high fevers particularly if you have underlying diseases Then you need to call your healthcare provider and certainly. If you're very ill jude call nine one one but informed them that you might have coated so that they could take all the proper precautions for their safety. Amy Asks what can we do to mitigate the site Oh kind storm and we will ask you what that is that seems to be. The lethal part of the infection can vitamin C help. Where do you stand with elderberry? So obviously some nontraditional treatments. There have been some hospitals in New York that are I think injecting people intravenously with high doses of Vitamin C. It's been said that they've done that. In China I don't know if there is any scientific evidence to support that but I what is the site. Oh kind storm. So part of the body's reaction to any infection is we release these immune mediators that help us fight infection but they also at times can damage the lungs and the other organs and this is one of the reasons that we felt that young people had higher mortality in the nineteen eighteen seventeen eighteen influenza from the site of kinds You know there are things that could be used in the hospital such as steroids that blunt that response but actually steroids are likely to increase the risk. So we really don't have any good way of blunting that response now in terms of other things such as vitamin C. Zinc. There's not any specific data aware up yet about Cova but for other viral respiratory illnesses. Particularly helping you fight off a mild infection. There is evidence that vitamin C within a reasonable amounts and think when used appropriately can help mitigate some of those symptoms elderberry. I'm not aware of Any activity in this regard But it may maybe present to. I'm just not aware of that drunk. We have seen some absolutely fascinating videos from an organization called Med cram. Med C. R. A. M. dot com. And they've talked about the role of zinc against covert nineteen. And that's what they suggest that the hydroxy chloride win. Malaria drug actually helps zinc. Get into the nucleus of the cell into the cell itself where it can actually exhibit some antiviral activity. So that's in-vitro do. We have any evidence that this drug could work in. Vivo that is to say in people. The pilot studies have been mixed re have produced mixed results. It seems that The enthusiasm might have been a little overstated in those press conferences last week so Chloroquine is active against many viruses and the test tube hydroxy chloroquine a little less active in the test tube there have been studies of Chloroquine for other viral diseases like Dengi And flew and it is not proved to be successful for the other viral diseases. There's at least one. Viral disease took a younger fever for which Clark van actually seemed to make people worth so there are many trials on on going in the United States. There are trials and China. Obviously they're still pending and we do have to be aware that the drug does have some cardiac toxicity It can also cause problems From the nervous system and people with underlying diseases such as Gaon Beret and others So we have to use it cautiously proper doses and the trials will tell us in fact If it works probably I would guess. Within the next month to three months we'll have trials being published That are properly controlled and give us good data and that's also true for the antiviral remnants severe which is being tested around the world as we speak and the difference. Desa VIR is in the test tube. At least it is highly active against krona viruses including SARS mergers and and cove. It This drug has not been tried for any other viruses But it certainly went as high hopes that this drug might work. It's available on a number of trials and compassionate plea from the manufacturer But as yet no data really on well controlled trials. Philip wants to now if he's staying home and he's uncertain about whether he should call his doctor He hasn't been tested for Kovac. Nineteen what symptoms would impel him to seek emergency medical care so again. The symptoms of of this are the standard symptoms that we would expect to see with any viruses such as influenza particularly Cough fever and shortness of breath or the sort of the key coughing shortness of breath have been the two most prominent ones. Certainly people often have a runny nose sneezing so a throat. Profound fatigue And Myalgia muscle aches again. These could all be Just regular influenza they could be the non novel Krona viruses that we see but it certainly could be a covert as well and seeking emergency. Care if you're having trouble breathing right. Yes certainly if you have very high fevers. You are not able to take down fluids. You're developing a severe shortness of breath to the point where you really can't breathe. That piddly can't eat All of those would be indications to call your provider. If you're a critically ill obviously call nine one one. You're listening to Dr David Weber Professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina. School of Medicine. He's also professor of epidemiology at the School of Global Public Health and medical director of UNC hospitals departments of hospital epidemiology. We are going to take a short short break briefly. A when we come back we're going to talk about some other potential treatments. We WanNA find out about a century old vaccine called BC. Gee why are they starting to administer this vaccine to health professionals in the Netherlands and in Australia and if the measures are taking now to limit people interacting with each other are successful at slowing the spread of Covet nineteen will it be safe to lift the restrictions. We're taking your questions about corona virus by email. You can join the conversation radio at People's Pharmacy Dot Com again. Email US radio at people's Pharmacy Dot Com. You're listening to the People's pharmacy with Joe and Terry Graydon. This people's pharmacy podcast is brought to you in part by VERIZON DOT COM VERIZON. A lab offers home health tests that allow you to monitor your hormones and health conditions. You can take control of the quantitative assessment of your health and learn about male and female hormone balance the stress. Hormone Cortisol Leaky Gut. Gluten intolerance or your gut microbiome take a more active role in trucking your health and take twenty percent off your first order of a mailing testing opportunity with the discount code. People that's P. E. O. P. L. E. All upper case to learn more go to verizon a- dot com that's the E. R. I S. A. N. A. Dot Com. Welcome back to the People's pharmacy. I'm Cheri Graydon unarmed Joe Graydon. The People's pharmacy is brought to you. In part by COCO via offering plant-based nutrients in the form of coq AU Flab Anos for brain and heart health online at Koko via dot com and by Kaya -biotics probiotic products made in Germany from certified organic ingredients K. A. Y. -biotics dot com today. The People's pharmacy is a live corona virus. Update with answers to your questions. Our guest is Dr David Weber. He is professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina School of Medicine. He's also professor epidemiology at the killings school of Global Public Health. He's medical director of UNC hospitals departments of hospital epidemiology infection prevention. Dr Webber is Associate Chief Medical Officer of UNC. Healthcare in Dr Webber. We're extremely grateful to have you joining us today. Live on the People's pharmacy and we want to put a shout out again to all of your colleagues all across the country around the world the physicians the first responders the nurses the allied health professionals the respiration therapist all of the people who are in the trenches right. Now trying to save lives. I want to ask you a little bit about B C g It's been around for a hundred years. We currently don't have a vaccine but be. Cg is a vaccine. Can you tell us what it stands for? Bcg and what it's been used for and why doctors are getting vaccinated in Australia and the Netherlands and a few other countries so B. C. J. stands for a strain of a bacteria Allied similar. But not the dentist to mycobacterium tuberculosis. The agent that causes to Burke Yellow Sus and the vaccine has been used for You know hundred years to help prevent particularly children from developing Active Burke Yellow says it is not specifically a vaccine against Kofi but it is a nonspecific stimulator of immune function and by boosting the antibodies in general and the ability of the body to fight infection. There is hope it might diminish the risk of people acquiring coated and. It's being tested now in Australia. I know among several thousand healthcare personnel. Who are on the front lines. Obviously caring for covert patients as a way of reducing their risk of acquiring cove. It now of course what we're worried about our shortages you know. Bcg is used for bladder cancer. It's incredibly effective. It's it's one of the early immuno therapies but it can be very hard to obtain and I'm worried that we you know if there are positive responses in those health health workers in Australia and the Netherlands and other countries will we be able to make enough B C G for the population and that would be a major problem to clean the United States in many parts of the world to BC. G is given to every a young child in the United States. We haven't used this vaccine in decades because our Rate of tuberculosis is so low so quickly in the United States unless we could get supplies elsewhere Least in an immediate short period of time. develop Having access to large amounts of it would be very difficult in addition And people who are immuno-compromised Such as with cancer as an example or other severe compromising conditions. Bcg occasionally can spread within the body and cause disease such as to burke yellow. So we'd have to be cautious in certain subgroups of our population. It is a live bacteria product and giving it to certain people Dr Webber other treatments that are being Tried out in various places that you are especially interested in so I think the most interesting one. We've already mentioned which is finding people who are now twenty one days Since the onset of the disease in a fully recovered Using getting their antibodies from them and injecting it into Individuals who are now a critically ill again. It's been shown to work In people with a Bola. There's certainly some hope. I know they're beginning to try this and trials in New York. Of course you have to be careful and not to transmit other diseases that are in the blood such as hepatitis. B Or Hepatitis C. But I think that's exciting. I know people have now screen many many different potential therapies for activity and the test tube against covert and there are more than thirty Potential other drugs that have been used. There are trials with some of the anti retrovirals Such a solo piano via Retana veer often combined with rival Viron. At least one trial did not show efficacy. But that's yet another set of drugs That's being looked at Dr Webber. We have a question from a listener. Who has identified herself as s? She says this may be a stupid question. I've tried to find the answers through the CDC but to no luck She says they're saying people who have the virus and show no can show no symptoms. Is it safe to have sexual relations with your spouse? You couldn't accomplish that whilst Dang six feet apart and that is certainly true again. The risk is When there is no evidence for this virus that is transmitted through sacs There is no evidence in fact that when we've had pregnant women who unfortunately become infected that it's transmitted from mother to baby again as other diseases like hepatitis. B can but however if you're within six feet of someone Particularly if they're symptomatic Then there was the chance of spread from the rest to retract from one person to another. So it's a question of distance not a question of sex Dr Webber. I am not absolutely certain about this but I think yesterday I spotted A report suggesting that mother to baby transmission In utero might be happening in some cases. We'll have to check on that and we'll put it up on our website. We do have a caller from Kerry rick. Welcome to the People's pharmacy. What is your question for Dr Webber Place? Yes I've seen the Many reports of what we should do with groceries and and Packages that come through our home and they seem to be all over the map. Can you elaborate a little bit more on that? The you know the I understand. The infection comes primarily from The proximity to other people but I've seen things that keeping your groceries in the garage for two to two weeks to to no time at all. So can you provide us a little more guidance in that area? Sure let me first say there is some good news about this virus. It has an envelope which means it's relatively easily inactivated so any. If the alcohol waterless hand products will easily inactivate this on your hands and Ten seconds soap and water removes it and any standard disinfectant to wipe Will also kill it so certainly you could. Just get a disinfectant white. If you didn't have something like that you could obviously just take some clorox and dilute it. One to one hundred those types of Chemicals disinfectants would Rapidly killed this virus so he can wipe things down if one is concerned. I know there's been a lot of concern about the transmission on on people products. I have not seen good data. How long it survives on the paper products and keep in mind detecting it with some of the molecular tests doesn't mean it's live virus and I've not seen any real studies or Epidemiologic suggestions that there is transmission through paper products. But that doesn't mean it doesn't occur when wanted to be particularly cautious. We could just wipe things down with disinfectant White Terry. You've done some research on the CDC website with regard to how to dilute bleach so it has antiviral activities. Do you remember what the formula is? Roughly speaking yes. If you have a gallon of water you put in five tablespoons of household bleach. If you have a quart of water you put in four teaspoons of household bleach and again if you don't remember that scared to check on it check the CDC website they have in they have a detailed instructions on disinfection and we have it as well on our website. Dr Webber. We have an email question from madeline she says. I am a geriatric nursing care manager going out daily to see clients in assisted living communities when. I'm allowed to go in. I have high blood pressure and I've been on lysine appro. I contacted my doctor about changing the medication. And he changed it to low certain. It's my understanding that ace inhibitors may increase ones risk of contracting. Kovic nineteen and making it more complicated. Is this correct? And she also wants to know whether that's also true of arbs. Which of course is the low certain she's currently on so this is an area of active study and it is true that the studies at China's suggested people with hypertension As we talked about with older individuals are more likely to have Complications with covert Now is it because of the hypertension or because of the drugs. We just mentioned. There is a indications that these drugs do alter the ability of the virus and how it binds to the respiratory epithelium and causes disease and it may be that both of these drugs Do enhance the ability of the virus to spread how important that is in everyone. And what Overall rolled is not entirely known. There is some evidence that They are detrimental in the sense of increasing The severity of illness with Kothe it as an epidemiologist you. I am sure have watched very carefully. The statistics from China. Wuhan in particular. You've probably been paying close attention to what's been going on. In South Korea and Japan Taiwan they seemingly have made pretty good progress against this virus. Whenever you see video of anyone in China in South Korea in Japan. Everyone has face masks on. I mean it would be. I think culturally unacceptable to go out in public in China or South Korea. These days without a facemask in the United States and in parts of Europe is culturally unacceptable to go out with a face mask on. I'm just wondering whether a face mask provides any benefit either in the transmission if somebody is sick with the Kobe nineteen virus or to protect people from catching so both the troops certainly When healthcare providers come into contact with somebody with known as suspected cove it? We do wear a face mask and it does Traumatically reduce the risk of disease by filled tink viruses out. If you're sick wearing a face mask decreases your risk of transmitting. It much like Taking tissue sneezing into the tissue and then discarding it. It's probably better to have it on to protect yourself. If you're not ill because if you give a sneeze coughed any air will escape around the sides of the of the facemask. But they are protective. Unfortunately as you know Face Max face masks have been in short supply and we would prefer Allowing people particularly if they're home not wearing face masks to the extent they can to preserve those facemask the frontline paramedics and others. Who really need them? Dr Webber we have an email question from Francis who wants to know if homemade fast face masks are of any use and there has been a a swelling of Volunteers people who are stuck at home. Want to do something to help. And who are now sewing face masks to make them available where they are So very In short supply so our homemade facemasks. Any help let me. I often start off by saying from my hospital. And all over the United States we really appreciate the public's response to helping us here at UNC and across the country people have offered facemasks Some that they have that are officially made Ones other homemade food many other things that they've done to support the people on the front lines and that's greatly appreciated but in terms of homemade face. Maths the answer is no the data suggests that just knitting a cloth mask or cutting it really actually may actually increase risks the facemask that approved and that we use a designed specifically to out a virus size particles. The cloth really doesn't have the same. The same filtering capacity and by actually getting wet and humid from the breath may actually increase the risk of infection. So we don't actually recommend that except possibly as an absolutely a last resort. I have a question from Gretchen. And Greensboro. She wants to know. Is there any evidence that high normal levels of vitamin D? Help fight off winter seasonal flu if so is a good advice to keep your vitamin D levels in high normal range and Of course we don't have any information about vitamin D against covert nineteen on the other hand the healthiest immune system. You can have presumably the better off. You're going to be overall so I think certainly in the winter it's reasonable for everyone to take a Multivitamin particularly those that have B. and C. And them for the reasons that we talked about there is really no evidence that D- as long as you are taking it with a multivitamin that pushing the level higher would help you and there are some concerns about the soluble. Vitamins A D E in K. Because if you take too high levels they accumulate in the liver and could damage the liver. Tekere Weber MINTA has a friend who is an MD Physician and wants to now. What is the advice for this person to stay as safe as possible in current practice so the first thing For any emergency department physicians and I just have so much appreciation for those people out on the front lines every single day like our paramedics providing care and with some slight We hope slight personal risk. Well the most important things are I obviously if you have any person patient who is coughing respiratory symptoms. You need to be wearing a mask Ideally Ninety five was there but certainly a mask gloves in practice good hand hygiene before and after any interaction with the person increasingly hospitals including the University of North Carolina. Many hospitals now have all of their staff. All of the patient context Wearing masks to do that sometimes we need to extend the US not one math per patient contact but extend the use and the Centers for Disease Control does have guidelines and how to how to do that so appropriate personal protective equipment. Masking the patient if they have symptoms trying to keep distance except when examining them Wearing gloves and good hand hygiene are the best ways we have for protecting oneself. Dr Webber. Can you tell us the proper technique for washing hands and using hand sanitizer? And what kind of hand sanitizer is best? So the best type of hand sanitizer is one that contains sixty to ninety percent alcohol. Most of the commercial ones often contain a monument to be nice to. And you place a drop in the center of your palm and that depends on the instructions. How much to put their and you certainly need enough to cover all the Skin Rub your palms together. Then rub the back of your hands very important. You need to into digit. Take your fingers rep in between your fingers and you need to Rub for at least ten seconds and should you leave the alcohol on your hands and let it dry or can you wipe it dry with the towel. Ideally you would leave it on your hands and let it dry and I should say soap and water is done the same way but this open to the palm Spread across the palm over back of both hands and then between the FA- fingers and again for a minimum of ten preferably fifteen seconds. Patrick wants to know what percent of the population needs to have developed immunity to reduce the risk of transmission. And is there a blood test that can tell you whether you are immune? Well I The blood tests will be coming online in the near future. And they will tell you if you had disease and therefore you are presumed immune and that can be particularly useful For those people donating some of their Sarah to help people who are critically ill but they would also know that their immune at particularly say they physicians can volunteer to see patients with a limited risk of acquiring new disease. I'm wondering if people have the blood test that reveals antibodies to the virus especially healthcare workers when they can go back to work and feel like okay. I'm protected and my patients are protected. I no longer have virus. So certainly we can get blood tests that would show that But generally the time it takes to develop positive blood test with most of the viruses is one two three weeks so it really is not going to be a very efficient way for telling when people are safe to go back. That's either based on symptoms as we talked about a week of since onset of your first symptom and at least three days with a marked reduction and no fever. You could do to repeat nasal swabs when you're A symptomatic looking for virus if those about negative twenty four hours apart Both would indicate that you no longer infectious Stewart wants to know. Can we expect the virus to move south into the southern hemisphere this spring and then back north again in in the fall? What differentiates viruses that are seasonal? And those that are not so respiratory viruses tend to be seasonal and we see them in our winter and if you go to the southern hemisphere like South Africa or Australia. They see them in their winter. Which of course is our summer and there are several reasons respiratory viruses peak in the Winter months in both hemispheres. One is where more closely endorse because of the cold? So we have more exposure to We heat our houses which dries out. Our mucous membranes may make us more susceptible plus we tend to have In the colder weather low temperatures and low humidity and the viruses survive. Better in the air and in fact. If you're on the equator you don't have those peaks they just see those viruses throughout the year. And yes I do expect that there will be a peak of of covert and the Southern Hemisphere and our summer their winter. And yes I suspect. Most likely we will see another peak here and the viral season and the next Fall Winter Dr Webber. There have been a lot of conspiracy theories that somehow this virus is man made that That the Chinese military might have been somehow involved in that process and the Chinese have said no no. It's the American Military Industrial Complex. That was involved. Can you straighten us out on those conspiracy theories place? Yeah first of all. None of them are true. Covert as did SARS and Moore's Evolved from bats. These are bat viruses not entirely clear complex. Why bath can carry so many viruses if you know. They carry rabies and other viruses There and then they've occasionally Over hundreds of years thousands of years some of these bat corona viruses leach over into humans And then we get pandemics Like we had with SARS and now we have with coasted sector Weber Iona says I received a B C g vaccination as a baby in an experimental program at the cradle in Chicago in the nineteen fifties because of this. I tested positive for TB as a kid whenever the skin tests. Were ADMINISTERED IN SCHOOL. Would that early vaccination help mitigate the effects of Kovic nineteen if I got it? The answer is probably not you certainly have By virtue having a positive skin test you have some immunity to mycobacterium tuberculosis. The bacteria that causes tuberculosis but the feeling BC G. is that it gives you this big nonspecific immune response in the weeks to maybe a few months after you have it Having had it as a child that immune responses long since diminished. And it's unlikely to be protecting you against Cosette. There has been words that the Cuban Medical Society has somehow created a Alpha to be recombinant interferon and they are administering it in various countries. I think possibly even in Italy do we have any sense at all whether a a immune modulating compounds such as this Interferon Alpha two B recumbent might be helpful so the answer is Yes it is possible that the use of Interferon might work. they Obviously increase the much like DC g the ability of the body to fight infections although in clinical treatments with interferon for SARS and Moore's they did not decrease mortality or decrease time to Viral resistance. So we don't have evidence from other corona viruses that interference work but again This is a different Corona virus and I think until we have a proven therapy We should consider all of these possibilities for clinical trials. Dr Webber Philip in Wells. Berg West Virginia says several years ago. I was hospitalized for five days with Numa sisters pneumonia. I had completed six rounds of Chemo. In two years of biologic for Lymphoma he understands that having had pneumonia once he's more susceptible and he's wondering whether in addition to washing his hands and keeping his distance Aerobic exercise or using one of those devices they have in the hospital where the patient inhales at a controlled rate to increase lung capacity would help protect the lungs so it's certainly true people with underlying diseases such as types of cancer at higher risk and it is also true that to the extent you live a healthy lifestyle. Don't smoke exercise right appropriate Diet all of those decrease your of acquiring Any of many infectious diseases. And I certainly recommend all of these for healthy life style tekere Weber. People have found a lot of stuff on the Internet. Some of it is excellent information and some of it is not at. Do you have any advice for people on how to sort the wheat from the chaff? Yes I think. The best websites are of course your local county and state health department websites. The Centers for Disease Control has an excellent website. And I think many many Academic universities including the University of North Carolina Johns Hopkins Many of those academic centers have excellent websites. That provide a wonderful information. And I would recommend going to those websites. Is there any additional advice that we should offer our listeners? Know I think what we need to do is be supportive of each other. The United States will pull together. We'll get through this. We need to minimize the effects of distancing on people who are older And have contact and we do need to have social interactions. Anything we can do to support our frontline. Personnel are critical in the long run. Obviously this is We will get through this pandemic. We'll be pandemics in the future. And so we need the federal government and the All of us need to support the infrastructure for us to fight the next pandemic by adequately training people in infection prevention and physicians and nurses in this and supporting the critical public health infrastructure. That will allow us to sex sexually. Fight this epidemic and the next one Dr Webber. We are almost out of time a very briefly. Your Crystal Ball what you anticipate over the next couple of weeks in the United States and around the world so I think that we will see increasing cases. for somewhere between two and eight weeks hopefully we will speak with our Physical distance thing and the cases will drop off. I suspect that. Different places. We'll have different hot spots and we'll have different peaks New York. I will have an earlier peak then probably Detroit. I think other hotspots will develop We need to keep in mind. That deaths will lag behind cases by about two weeks. So when the cases even though the cases start coming down unfortunately depths will increase the physical distancing will have two effects one is it will lower the number of people infected and just as important it will spread out the infection so instead of having the sharp peak over just a few weeks maybe over a a number of weeks this will allow us not to overtax hospital so everyone needs care Could be cared for in the hospitals. I worry about a second wave like we saw in nineteen seventeen eighteen with another wave and we need to be prepared for it when we have viral respiratory season. Coming up in the. Let's hope we have a vaccine by then and that is all the time we have today. Thank you for listening special. Thanks to our guest. Today Dr David Weber. He is professor of Medicine in the Division of Infectious Diseases and professor of pediatrics at the University of North Carolina School of Medicine. He's also professor of epidemiology at the Giggling School of Global Public Health Medical Director of UNC hospitals departments of hospital epidemiology infection prevention. Dr Webber is Associate Chief Medical Officer of UNC. Healthcare Vince seagal produced. Today's show special. Thanks to our. Dr Ski who engineered. People's pharmacy is produced at the studios of North Carolina Public Radio W. UNC. There's a lot that we still don't know but if you'd like to learn more you can visit our website at people's pharmacy. Dot Com in Durham North Carolina. I'm Joe Graydon and I'm Terry Graydon. Thank you so much for listening to join us again next week. Thank you for listening to the People's pharmacy. Podcast it's an honor and a pleasure to bring you our award winning program weekend and week out but producing and distributing. This show is a free. Podcast takes time and costs money if you like what we do and you'd like to help us. 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Dr Webber UNC United States Dr David Weber Terry Graydon DOT COM influenza Division of Infectious Disease New York professor professor of pediatrics fever school of Global Public Health Joe Graydon medical director CDC School of Medicine professor of Medicine Cova Associate Chief Medical Office
Children And Play, During A Pandemic

Radio Boston

19:07 min | 4 months ago

Children And Play, During A Pandemic

"Summer is here. The ninety degrees didn't tip it off. It also means school is out and parents are looking for fun things to do to keep those kiddos entertained, and if you're like me, I'm guessing you're asking some of these same questions. How do you make summer vacation fund in the middle of pandemic? Everything from trips to playgrounds team sports play dates all kind of underlined by this theme of what's safe, and what's not and I'm sure you've got your own questions about how to handle summer vacation with your kids. We're GONNA bring you. Great guests to help answer those so go ahead and jump on board. One, eight, hundred, four, two, three, eight, two, five, five. That's one eight hundred four to three talk. Joining us now is Dr Rick Molly. He's a senior physician in pediatrics in the Division of Infectious Diseases at Boston Children's hospital. And also a professor of Pediatrics at Harvard Medical School Dr Mollie Welcome, Radio Boston? Thank you for having me? And also with us is Peter Gray. He's a research professor of psychology at Boston College author of free to learn and founder of let grow a nonprofit. That promotes child lead. Play Peter Welcome back to you as well. Very happy to be here. So Dr Mollie. I want to start with you and ask you kind of where kids fit into this pandemic. If we go back to. When we first started learning about corona virus, there was some concern that they'd be so called super spreaders. Have we learned any more about the role? Kids play in spreading Kurna virus. I think we have although there's still a lot to learn at the outset of the pandemic. Exactly as you said, most people really thought this was going to follow the same pattern as other common respiratory viruses like a flu where children are really unfortunately, the main vectors of transmission, and so a lot of people were worried. That was going to be the case, but we had read reports from China that really indicated that children were somewhat wore likely to resist the negative consequences of disinfection and not get quite as sick, so that was the first puzzle. The second puzzle was that we found. Found out from other countries like Iceland and and Israel and other countries across the world that not only were children less likely to get sick. They were also less likely to even catch the virus in their nose, and therefore less likely to spread it now it. It isn't to say that they can't get sick from the virus. We certainly have unfortunately many examples of that, but they do seem to be more resistant to getting sick, and they also seem to be probably more resistant to serving as ping pong players to spread the virus across their families or other members of the community. It's really interesting. I've got a son who will be five this summer and so I can tell you firsthand wearing masks washing your hands. It all looks great on paper. That can be a real challenge. Actually on the ground kind of any general advice for parents in terms of how to keep your kids safe as we're starting to enter the summer months. It's very interesting and important question. You're asking I. Think we all recognize that? Our dream of running around in a park on the beach with our kids not involve them wearing masks, and and stings exceeded away from from other children or other. People even you know and are friendly with. But I do think that we have to take a certain amount of precautions, because even though children are less likely to get sick and less likely to transmit probably bay still can get sick and make still probably spread the virus, and therefore the recommendations we make is to if the child is old enough like your children old enough to understand what we're trying. To. Explain to them that you can have fun. You can be outside. In fact, we want you to be outside, but we want you to follow a few rules that did not exist until six months ago and those are the rules of staying a little bit away from people who are not directly in your family unit, or in your social bubble, and also, when and if the child is willing to wear a mask so that they do not infect others and I think that's a very empowering statement. You can make to a child to say that the reason they're wearing masks is to make sure that they're keeping all the other people safe as well. It's a great way to look at. It Peter I want to bring you in here and and we are going to. The solicitor calls and questions as well one, eight, hundred, four, two, three, eight, two, five five. If you want to join the conversation. Peter I mentioned in your intro you. You've spent your career researching play. Can you talk a little bit about the importance of play in a child's development? And what have you seen in the last few months during the pandemic? Play as crucial to children's development and much of my research shows that over the last few decades our children have been very play deprived We put the spent so much time in school so much time at homework after school so much time in adult directed activities which are not fully play play as activity that children develop themselves. Children take control of themselves. Where children learn to be independent and solve their own problems, so I've done a lot of research that shows. that as we as we deprived children, more and more of free play. We get more anxious. More depressed, less resilient children we have. Huge increases in childhood suicide over the last several decades, and the which of course is just the tip of the iceberg And what my research suggests, it's because children are so often in stressful competitive kinds of activities such as school. And have so little time to adjust really be children. To play. So what's interesting right now? Is, all these things that have kept children's so busy have been shut off. And what the consequences of that well the LET Grillo? Nonprofit which have apart of. has recently completed. A major survey of families across the country surveyed eight hundred families pretty well balanced for socio-economic group geographic. Placement and so on these are families that have children between the ages of eight and thirteen, and we asked a lot of questions about how. The parents are coping the questions to the directed to the parents and questions directed to the target child within the family. Let me just give you a little bit of the data. The data were surprising even to me. And I think they will be even more surprising to others, so one of the. Was to the children. Are you more calm now or less calm? Than you were when you were before the before the school closures forty nine. Said more calm. Twenty five percent said less calm and the rest said about the same the parents, the same question, forty three percent said they are now less stressed. Twenty nine percent said more stress. The others said no difference now. Here's something that you know you introduce this by saying. Keep kids entertained. The interesting thing that parents are learning is. They don't have to entertain their cats. Kids are pretty darn good at finding ways to entertain themselves. It took a while some cases up. They were bored. Boredom is a good thing. They figured out what to do, so we got responses from the kids saying things like. You know I've owned a guitar for two years and I've never had time to learn to play it. It I have learned to play the guitar and you watch on Youtube played the cutter. We've heard from many kids who are riding bicycles for the first time a match that we were growing a generation of kids who aren't learning to ride bicycles because they're kept so busy, also because we're so afraid, they'll get hurt out there in the bicycle well, the traffic slow down for a while. Kids didn't have much else to do. This is a safe way to get out and play so. I've heard from parents. I can't buy a bicycle. There's a run on bicycles you know so. There's an interesting phenomenon here I don't want to say it is interesting I don't know obviously. Obviously and obviously there are family suffering. Obviously, we probably didn't hear from the families that. You know that you just hate one within the family. You don't want to be stuck at home with their. We probably heard from the families who are coping a little better than some of the other families, but what's really interesting is these these parents are saying I am impressed by my children. They are. They are more responsible. They're taking more control themselves. Many of them are doing homework. They're asked how it is interesting. Housework that I didn't think they were capable of doing. It is interesting that A lot of what you're talking about obviously sounds great, but there is a privilege component here to right not everybody can go out and buy a bike or has space in a backyard for kids to play or. You know maybe parents who are frontline workers who are still having to go into the office and they're trying to figure out childcare situations. How? How are you thinking about that as you're processing the data? I think that's a very very good point, and it's it's It's hard to know but what I can tell you. Is that the problem that existed before this pandemic? Is across social class. It's across race. Children have been suffering because of deprivation of play. and. Primary reasons for the deprivation of play is not having time to do it, and because we're living in a world where people feel that, it's unsafe for children to go outdoors. We've exaggerated the dangers and this is across social class. There was a time a couple of decades ago when this was more common in the. so-called more privileged classes, they were more overprotective of their children than within then and then people who are economically less less-privileged. Now. This is across social class. Partly because people are afraid, they'll be arrested if they'd send their children out to play. A buzzer can of worms. We could get into another time I do want to make sure we get some calls in here, so let's Let's go to the phones seibu in Sudbury. is on the line welcome to Radio Boston Seibu. Thanks for having me my question in this context kind of maybe. And and I'm hearing all the benefits and I think I agree with with some of those things that that are intrinsically happening with trying to expand. Ways that children are staying busy My comment would be you know I'm very personable person and I like to think my son is four and a half is also developing to be the same way. How do you start to explain some more of the uncertainty around just running into folks say in public areas where you are trying to get outside That's kind of my first question, and my second question is in terms of. How do you keep your so more? The the flip side of that your private circle? How do you sort of ensure that folks are taking it seriously? You know the virus seriously and being able to interact with them. both indoors and outdoors right because some are summer will come to an. Thank, you yeah, that's a great question documentary. Let me bring you in on this. Because I think socialization obviously has a number of benefits. But how do you balance that with the health concerns? Yeah it's it's a challenge. We've all been facing I think it. It's helpful to remember that even know. We can't put a number to the risk that is associated with for example crossing somebody in the hallway, or or on the elevator, or even in a park, just running into somebody in sort of even bumping into them, and then moving away. It just doesn't seem likely that that represents a huge risk of transmission, and therefore when one tries to explain to children depending on their age, of course, what should or should not be done I think it can be done in a way where you're trying to explain to the child that it's important to reduce those interactions to limit that type of. You know close contact if you will with somebody that is not part of their family or their social bubble, but without giving them this fear. This thing Zaidi that all of a sudden they've entered some sort of radioactive zone when they're in in the face of someone that they don't know I think that really can help quite a bit to reduce the anxiety in frustration that people might have. I do think it's absolutely critically important that we take advantage of good weather that we take ring kids outside that we we re engage in the type of activities that make our kids healthier and happier. Without creating the sense that just because you're temporarily in very briefly closer to someone. Then maybe you and I would like for a child that that is going to represent a significant risk. Yeah I'll go back to the phones at one, eight, hundred, four, two, three, eight, two, five, five Danny in Cambridge. You're up next. Welcome to the show, Danny. What's on your mind? Thank you so much for taking my call I'm a question for your gas. I have a twenty seven month old and forget about the fact that I can't get this kid to put on a mask to save my life. He hates when I wear my mask. It really bothers him and my question. Speak of I. Language I got an eighteen gets during the say cries as soon as it goes on. Each us, it's awful and you know. daycares are opening back up. Our daycare centers opening back up at the end of July, and I think the thing that concerns me is I know that developmentally small children are really reliant on facial expressions. And what scares me, you know. What is this going to affect our children developmentally when they go back to daycare? And you know their teachers all have face masks on you know. How are they going to be able to read their expression to connect with them to form those bonds and those connections that will affect them for the rest of their life. Is this something that I mean you know? Is this something that we really need to be concerned about and if so? How do we mitigate that? How do we rectify that at home? Great Question Danny I'll throw that up to either you Rick Molly Peter Greg whoever wants to have thought to that which which bay surprise some people. You can see facial expressions on zoom or on the computer. So one possibility is with little kids. Let them interact with their friends and other people over the computer. At least not, it's not perfect it doesn't. It doesn't take the place of physical hugs. And jostling all of that, but at least it's If you're concerned about losing the opportunity to respond to physical expressions, you know of course during this time we've all been on Zuma heck of a lot more than we ever were before and I think what everybody's finding is. It those computer of when you're when you're looking at one another. It's It's certainly better than being on the telephone. It's It's you're you're interacting. With go back to the phones. Here revealed in Cambridge up next Ravizza. What's on your mind? Hi Thank you for taking my Cole. I WANNA ask Dr Mollie. He mentioned You mentioned a social bubble, and I was wondering. How many families do you recommend to connect together to form that bubble? It's a great question. Dr Mollie. What do you say? You know I think like anything. It's a matter of knowing your. Your friends and the members of your bubble in other words. If you sent to me, I have to families that I'm very close to, and they have kids and we have all pledged. To really only see one another and nobody else. And that could amount of age. Have a couple of kids. You have a couple of kids that can amount to like a pretty big group of people but as long as everybody is respectful of that contract. To the extent possible, then I think that's not an unsafe. Situation what you don't want is a situation. Where for example, your your friends are part of six different social bubbles sort of jumping around from one group to another in another because then unfortunately. The whole contract is basically void as far as I'm concerned and so more than the number of families that you're willing to include. I would consider it using your own judgment of how much risk you're willing to take for yourself and for your families, for example, restaurants are now. Open indoors outdoors. personally I think it's very rational to try to decide for yourself whether you feel more comfortable with people who are going to be for example, eating outdoors at the restaurant rather than going inside, and that might be a way to judge whether people in your bubble are respecting that same degree of risk that you're taking on for your own family and that might help you decide. Go ahead go ahead. I was GONNA I was GonNa tag another on. We don't have time for any more calls. But the Karen and Carlisle was gonNA. Ask about her fifteen year old, and whether they should be babysitting small kids. I'd imagine your advice is something. Similar lines understand the family's. You'd be working with how they're approaching the situation. Yes I think you're absolutely right. It's it's. It's good to get that information. These days fortunately, it will not be viewed as being intrusive to ask people how they are managing the pandemic. Actually, it's a very interesting conversation I think you know people learn from one another that way what works what doesn't what makes them feel comfortable and I think if somebody wants to have a job such as babysitting, it would be very important to understand what the other family is doing. Let's talk to Rick Molly senior physician in Pediatrics in the Division of Infectious Diseases at Boston Children's Hospital and a professor of Pediatrics at Harvard Medical School Dr Mollie. Thanks so much for the time. My pleasure. And, also with US Peter. Gray reports professors psychology at Boston College. Author of free to learn and founder of let grow a nonprofit that promotes child lead pay a play Peter. Thanks so much for your time to. Thank you for having me on.

Rick Molly Peter Greg Dr Mollie Peter Gray professor of Pediatrics Danny Boston College Division of Infectious Disease founder Boston Children Dr Rick Molly Boston Cambridge professor of psychology Youtube Boston Children's Hospital Harvard Medical School flu Peter I China Harvard Medical School Dr Moll
Show 1141: Which Health Risks Should You Worry About?

People's Pharmacy

58:55 min | 2 years ago

Show 1141: Which Health Risks Should You Worry About?

"The people's pharmacy podcast is sponsored by the brain gauge developed by neuroscientists at the university of North Carolina to study brain function across a wide range of applications including aging and traumatic brain injury, the brain gauge, translates state of the art neuroscience into easy to use methods that let you take control of your brain health now. Available for home research and clinical, applications, find out more at gauge your brain dot com. Do you ever? Get fed up with scary health headlines about the risks of coffee wine or bacon. How can you make sense of them? This is the people's pharmacy with Terry. And Joe Graydon. Dr Aaron Carroll is a pediatrician and expert on health research and policy. He'll offer us advice on making sense of health risks. We know the sun raises your risk of skin cancer. No, one says never go out in the sun. They say take proper precautions and think about how much doing because you don't want to raise your risk too much. Putting scary statistics into perspective requires more than a headline distinguishing between relative risk and absolute risk is critical to making informed decisions coming up on the people's pharmacy. How did tell which risks you should worry about first this news? In the people's pharmacy hills, headlines, popular blood pressure. Medications called ace inhibitors have been associated with an increased risk of lung cancer. Lisin appeal is the most prescribed drug in the United States over one hundred thirty million prescriptions for this, Angie. Tencent. Converting enzyme inhibitor are dispensed annually that doesn't take into account. Other ace inhibitors such as bananas Apprel capped Apprel, and now Apprel ram Apprel and Quinn Apprel such drugs are very effective at lowering blood pressure. But a new study raises questions about the safety of long-term use the investigators collected data on nearly one million hypertensive patients in the UK between nineteen eighty eight and two thousand fifteen taking an ace inhibitor was associated with a fourteen percent increased risk of lung cancer. This only became detectable after five years of us. The longer people took such drugs, the greater the risk after ten years the risk increased to thirty one percent, the authors point out that although the absolute risk of developing. Lung cancer is very small so many people are taking these medications that the number of patients affected could be quite large. It's difficult to diagnose Alzheimer's disease in this early course. In fact, a definitive diagnosis has only been available upon autopsy. Now, scientists have found markers of the disease that can be seen in the retina of the eye even before people notice serious memory loss. The noninvasive test called optical, coherence, tomography and geography could be done by an ophthalmologist and is able to distinguish between people with mild cognitive impairment, and those who progress to Alzheimer disease in Alzheimer's disease. The retina has fewer blood vessels and the inner layer is thinner. These observations were made independently by two separate teams of researchers and presented at the annual meeting of the American Academy of the Malla. Gee, it's been almost two decades since the FDA approved a pill to treat influenza that was Ozil town of ear also known as tamiflu last week the agency approved a new flu pill Zo flu can be taken by teens and adults who have had symptoms for less than two days, and it shortens the duration of flu symptoms by more than a day patients take just one pill instead of a series of pills. So it is much more convenient than other flu treatments so flu so works on a completely different violence. I'm than tamiflu in relentless so flu viruses, have not yet developed resistance side effects. Abso- flus include diarrhea bronchitis. Nausea and sign you side. His public health officials stress that antiviral drugs do not replace vaccination as. As the first line of defense against influenza people with mildly. Elevated blood pressure are usually given a prescription for an anti hypertensive medicine. However, previous studies haven't really demonstrated whether such drugs prevent cardiovascular complications in low risk patients. British researchers reviewed long-term medical records of adults with mild, hypertension. They define that. As blood pressure between one forty over ninety and one fifty nine over ninety nine without medication. More than nineteen thousand people. Taking blood pressure pills were compared to nineteen thousand other patients with similar blood pressure. But not taking medicine during the nearly six year follow up period, they found no evidence that treatment prevents cardiovascular disease or death. The medications did have side effects. However, most notably low blood pressure fainting electrolyte imbalance and acute kidney injury. The off. Authors conclude this pre specified analysis found no evidence to support guideline recommendations that encourage initiation of treatment in patients with low risk mild, hypertension, gum disease has been associated with type two diabetes osteoporosis, rheumatoid arthritis and a number of cardiovascular complications. Now, researchers report that people with poor oral health appear to have a harder time controlling their blood pressure. They review data from the US national health and examination survey and found that about half of the participants had gum disease. The worst the Pero Donald assise the harder it was to manage bloodpressure. Perio? Donald therapy. Reduced the likelihood of anti hypertensive treatment failure. And that's the hill. News from the people's fund. See this week. Welcome to the people's pharmacy. I'm Terry Graydon. I'm Joe Graydon. Do you ever get confused and frustrated by conflicting health headlines one month coffee's bad for you? The next month is going to prevent diabetes heart failure, and maybe even Parkinson's disease for years. People were advised to keep their egg consumption to a minimum. Now, we're told that eggs won't clog your arteries after all how do you deal with all those flip flops is there a way to make sense of the contradictory headlines without getting whiplash? Sometimes you may feel you need a resent us down to crack the code. Well, we have just the guide you need. Dr Aaron Carroll is a professor of pediatrics and associate dean for research mentoring at Indiana University school of medicine, he's also director of the center for pediatric and adolescent, comparative effectiveness research, he focuses on the study of information. Technology to improve pediatric care healthcare policy and healthcare reform in addition to his scholarly activities. He writes about health research and policy for the New York Times, among other outlets. His most recent book is the bad food bible how and why to eat sinful iw. Welcome back to the people's pharmacy. Dr Aaron Carol thank you so much about me back. Dr Carol, you know, you are the one person we go to all the time when we have a question about some new research. Who was a study that was published several weeks, maybe several months ago about the the horrors of alcohol even one drink is too many, right? Wondering shorten your life dramatically, and then, you know, millions of people go, oh my goodness. And I even heard on television physicians, you know, MD types saying, oh, yeah, alcohol, it's really bad for you. And so you've kind of put it into perspective. Help us understand statistics probability. And what those studies mean for us? So this study got a lot of media attention, and it was portrayed in very much the way that you're describing it with headlines like there's no safe amount of alcohol, and, you know, lots of news stories arguing that even one drink is too much. So it's important to understand that this was a population based study, which is trying to get across a population base message, and that's perfectly reasonable and this. Has certainly pretty much the largest study of its type ever done was a meta analysis or a study of studies that granted together all of the observational studies that exist. It had looked at least twenty three different alcohol related problems that could come from that they gathered together hundreds of sources to estimate how much people might be drinking worldwide and put it all together. And basically they found that very high levels of drinking. You're very likely I have many of these problems, and there's a pretty consistent dose response, or at least it gets worse as you drink more and the lowest point was zero. And that's how they came out with those headlines, but there's a lot of things we have to consider what studies like this? The first is that it's Oster facial data. It can easily be confounded. There could be unmeasured factors that are contributing to the harm people that drink also smoke people to drink off tend to be poor. There could also be genetic differences or obesity differences, all of these would matter, and none of them could come into the play when they were actually looking at the study because the only thing they data for was basically age sex and location, and that's not the researchers fault. That's probably all they could do. And if you're going to model population level wide effects, that's fine. But they and a lot of the media then carried this individual level risks. And if you've got to make a claim that even one drink a day is really dangerous. Well, it's it's important to understand first of all what's the magnitude of that risk. And this is going to get a little into the numbers, but it's important to understand. So for every hundred thousand people who drink one drink a day nine hundred eighteen will probably have one of the Twenty-three related alcohol problems in any year, but of one hundred thousand people who drink nothing nine hundred and fourteen would experience one of those problems. This means that of one hundred thousand people ninety nine thousand eighty two will not be affected by drinking drink nine hundred fourteen will have an issue. No matter what they do only four in one hundred thousand people who drink drink a day might have one of those Twenty-three related. Problems that is an incredibly incredibly small risk. And no one should be assured that we've proven causal data from this study, even at true drinks a day. The number of people who experience a problem goes up to nine hundred seventy seven hundred thousand but again, nine hundred eighteen of them would have a problem with no matter what even at five drinks a day. We're only into the low thousands of people who might have a problem out of one hundred thousand and no one would argue that five drinks a day is a good idea that is too much. And so I'll Kahal ISM is terrible. It really is and drinking too much is really really bad for you. But the actual potential harm from very low level drinking or or even light to moderate drinking is very very small does not hit everyone equally and to take these kinds of studies. And then they huge sumptious about how it's going to affect individuals is really really going too far. Now, Dr Carol you said we can. Make causal inferences from this observational data. That's that is kind of a problem, isn't it? It is. And with some things like smoking. You will hear I've mostly tobacco. And she, but you'll hear some experts at what we've never proven that smoking causes cancer because we have no randomized controlled trials. But the odds ratios and the damage the numbers of people who have these are so great. And so large that at some point we say, okay, we're not going to do a randomized controlled trial, but we can pretty much prove it these are incredibly small numbers, and we could do a randomized controlled trial of alcohol. In fact, one was really in the works until some articles in the New York Times which actually reported on ethical concerns in the ways it was being pitched to funded by industry got it shut down. But that doesn't mean that we couldn't do a trial of light to moderate drinking, and that it wouldn't be in the public interest and wouldn't be worth funding. It absolutely would be. I'd also point out. We do have some randomized control. Field trials of alcohol where people were randomized to water or red wine or white wine, for instance, and it has been shown to have positive effects with respect to perhaps the prevention of diabetes markers or lowering of them and also with respect to some markers that would show cardiovascular risks. So if anything there's a little bit of evidence that light to moderate drinking might be beneficial in that respect, we won't know the true causal effect until we do a real randomized controlled trial. We probably should if we really want to close the door that, but until we do that to keep making huge claims from vast huge observational studies that you'll very very tiny rest. We're cheating statistical significance without necessarily achieving clinical significance and doing another meta analysis is not gonna do us. Any more good? We have about as much knowledge as we can get out of observational studies. If we want new knowledge, we're going to need a big randomized controlled trial. Thoughts are Carol. We probably should describe the difference between all epidemiological studies case control studies observational studies and the gold standard are CT's randomized control trials could you give a quick overview of the difference between these German Y R C teaser so much more important. So this study is a collection of studies that we would call mostly cohort studies, which is basically they get together a huge bunch of people. And then they check and see whether they have disease, and they also ask them if they have been drinking, and if they're drinking how much if they gathered them together and they follow them forward. That's a that's a prospective cohort trial. If they asked him about things that have happened in the past that's a retrospective cohort Trump and what they do is. They can sort of identifying what we call. Either odds ratios relative risks where they can say people who have been drinking are at higher risk or more likely or less likely to have. Diseases or problems than people who don't drink the problem with observational. Studies is that they can be what we call confounded where there can be a link or a relationship between alcohol consumption and bad outcomes. But there could be something else in between that is the cause of that some of the things I've already mentioned already, for instance, people who drink tend to be more likely to smoke. We know smoking causes all kinds of health problems. And it could be that people who drink it's not the drinking that's causing the promise the smoking. It could be the people who are drinking are poor. And that often tends to be the case. And when we do these kinds of studies therefore, it looks like it turns out that it's the poverty, which is much more risky. In fact in a previous study like this. They found that alcohol was associated with worse outcomes. But when they broke it down, they found that actually beer consumption was was associated with worse outcomes. But wine and spirits were associated with slightly better outcomes. Now. No one is arguing that wine and spirits are good for you. It's just that people who drink wine and spirits tend to be wealthier. And again, poverty is associated with a huge number of health problems. So without the ability to control in some statistical for fashion for all these confounding measures, you can wind up with a result that there's an association, but that's not the cause it's not it might not be the drinking that is causing the bad outcomes. It might just be the people who drink also tend to have other issues, and those things are what are causing the bad outcomes. The only way to be really sure this. In fact, one of the few ways to sort of get a 'cause -ality is to do a randomized controlled trial where we take people, and we randomly assign them to drink or not because of that we can be assured or more assured that there's not some factor that's associated with their choosing to drink or not where we're randomize ING where making it by chance. And if we just randomized people to drink. Or not. And then we see that there's a relationship between drinking and some outcome. We can be more assured that the drinking is the cause of that outcome because we've not allowed the other factors to confound the results or to prejudge or to change whether or not people are going to drink or not so to really get it. 'cause -ality to really figure out does lighter moderate drinking caused these kinds of health problems. We'd need to do a randomized controlled trial. You've been listening to Dr Aaron Carroll. He's professor of pediatrics and associate dean for research mentoring at Indiana University school of medicine, he's also director of the center for pediatric and atlas and comparative effectiveness research his books include the bad food bible how and why to eat sin Fily, he spoke with us from his office, which is next to a busy highway after the break. We'll discuss why. Nutritional studies can be so confusing. Some studies about how to get children to eat more healthily sounded good, but aren't based on sound science part of the problem is that studies that find no difference. The no hypothesis are much less likely to get published. So how would you know about those results, and how does that affect our understanding of drugs like antidepressants safe and effective? Are they? You're listening to the people's pharmacy with Joe and Terry Graydon. The people's pharmacy podcast is sponsored in part by Kaya -biotics, K A Y A -biotics offers the first probiotics which are both certified organic and Hypo allergenic I'll probiotics are produced in Germany under laboratory conditions with high quality ingredients and under strict regulatory oversight. The three available formulas are created for very specific purposes such as strengthening the immune system, fighting east infections and helping with weight loss to learn more about Kaya -biotics, probiotics and the important topic of gut health you can visit their website Kaya, -biotics dot com. That's K A Y A -biotics dot com. Use the discount code people for ten dollars off your first purchase. Welcome back to the people's pharmacy. Ontari graydon. I'm Joe Graydon. If you would like a purchase a CD of this show, you can call eight hundred seven three two two three three four. Today's show is one thousand one hundred forty one that phone number again, eight hundred seven three to twenty three thirty four or you can find it online at people's pharmacy dot com. You can also download the podcast from I tunes today. We're taking a look at health risks, which ones do you really need to worry about. And how would you know, most of us are easily confused when it comes to the statistics we encounter in articles about medical research, drug companies are very good at using statistics to their own advantage. How can you defend yourself to help us better understand risks and benefits? We're talking with Dr Aaron Carroll. He's professor of pediatric. Trix and associate dean for research mentoring at Indiana University school of medicine, he's also director of the center for pediatric and adolescent, comparative effectiveness research, he's written three books debunking, medical myths. The most recent is the bad food bible how and why to eat sin fully. Dr Carol we've been talking about the problems of observational studies, and this may help to explain I there's so much confusion about nutrition. Studies people get all kinds of upset if we tell them one week that coffee is bad for you. And then three months later, we tell them no coffee's good for you. Or we say don't eat butter, eat margarine. And then we turn around and say, oops, we were wrong. Of course, we would never say those things. But that's what the media tends to do like, oh, don't eat butter and then ten twenty thirty years later. It's like, ooh, margarine wasn't so good after all, and then there's the whole saturated fat cholesterol story. And so when it comes to nutrition there is so much confusion in large measure because of these observational studies. I would say I go further and say, it's not even just because of the observational studies. It's also because of the way we interpret research and the way that we talk about it and covered in the media. So we can start with the fact that I think you're correct that a lot of these studies are finding associations and those associations are often statistically significant and on necessarily clinically significant. And from that, we extrapolate there must be a causal pathway. And that one thing these things must 'cause one of the others when it's not true. And therefore, if we do another observational study where the associations are just different because it's a different population or something else, we can find a very different result. There's a classic study. That was published in the eye. Kim was I think it was two thousand twelve by John wanted us, which they took a cookbook, and they randomly picked fifty ingredients in the cookbook, and then they went out and looked at our their studies that show whether these fifty ingredients cause or prevent cancer, and they found research on almost all of them. I the more than forty. But what was interesting about? It was they can find studies that showed pretty much all of those ingredients both caused cancer and prevented cancer. In other words, you could find a study that said it made cancer less likely and for the same ingredient, you could find a study where cancer would be more likely. This is part of the problem with how we do nutrition research. We we isolate these individual nutrients, we try to study them all by themselves without recognizing that. Of course, they are completely confounded because they're being eaten along with tons of other foods, and in ways that that have all kinds of issues, we know that these studies are often very small they are often for very short. Periods of time. They often involve very few subjects and because of all of that together. The results are not nearly as robust or powerful as we think they should be or we would like them to be even when they're a randomized controlled trials. They're often for weeks involving tens of people and. And again with outcomes that are not long term or in ways that we care about those. They don't follow people enough to actually look at death or true health, or will you cancer? They're following biomarkers or laboratory values that fluctuate all the time and never turn out to correlate with what we actually care about. But part of the problem is also how we talk about this. Every new study is greeted as if it's an evacuation. So if there is a study with thirty people were they find out that dark chocolate is associated with some outcome that they care about they breathlessly pronounce it. Oh, we've proven that that this is true. There's a relationship dark chocolate is good for you without saying, but we have tons and tons and tons of research already in this area. Does this change our minds or is it just a tiny study in a huge sea of data? We don't do that. We don't take the large view. We don't look at all of these things together. And because of that we get misinformed and think that each new study is. Truth and we've waffle from one direction to the other direction. Instead of saying look, we've a ton of research some of it goes one way some of it goes the other way, therefore the likely answer is this doesn't make a difference at all. And if we took that sort of broader attitude, I think we'd have a better sense what's going on. But there's even another problem, then that involves publication bias studies, which are sexy studies which are going to scare people or make them think something that's really exciting are much more likely to get published and much more likely to get covered in the news. Then studies which are boring and so scientists whether or not they know it are seeking out the results that they think might get them to more likely to get some variety. And of course, they're being cherry picked out of the either the studies that are more likely to be exciting or to say, something new are more likely to get published more likely to covered more likely to get discussed more likely to get cited which gives us a false impression of what truth really is. 'cause we're seeing this. The sexy side of it or the exciting side of it, which often is not the true side of it. And so all of that together happens far too often in attrition research, which winds us with results that don't really hold up over time or give us a good sense of what we should or should not be eating. I remember learning in high school that it was just as important to pay attention to results if you do a study it's just as important to pay attention to resolve that don't arrive at the null hype. Or that I guess do arrive at the null hypothesis that say, okay, there is no difference. This. This doesn't make any difference. It may be scientifically important, but people aren't that interested in it. Right. No from across the board. In fact, I just wrote a column on this recently talking about negative results. We don't celebrate them. Like, we should we don't get excited about them. Like, we should we don't try to public. In fact, are much less likely to get published if we do publish them. We are much more likely to actually try to change, you know, even the outcomes that we're talking about our spin them as positive which can often be a problem, if they do get published where much less likely to discuss them in the media as I said, and so we don't care almost about negative results in the same way, we do positive, but that's not how science works. The scientific method is set up around trying to set up a hypothesis and then trying to see if it is true or not and finding out that it is not is just as important as finding out that it is. Unfortunately, that's not how we do stuff. Even all the way if you go far back to grants. You know, the H is looking for innovation. They want to be convinced that that something is going to be new and exciting, and it's going to lead to positive results that that they're going to care about institutions are going to get more excited academic institutions are going to be more excited more likely to promote you and to give you accolades if you're published in high profile journals and that comes again from exciting new positive results. That's what people wanna see in the media. That's what they want to see on the news and all of this together creates a scientific environment where we are pushing for exciting new counterintuitive bizarre flashy results and not sort of necessarily getting his hyped up about or excited about things which are negative. No, boring. But those kinds of buying sees the things that lead us to research. That's not reproducible and to research that doesn't necessarily reflect truth. Well, I do wanna talk to you in a moment about pharmaceutical stuff. Studies because that's as true for drug says it is for nutrition. But before we dive into the world of medications, I do want to ask you about a column you wrote for the New York Times, titled the cookie crumbles, a retracted study points to a larger truth, and I know it would be very tempting to say, I told you so within fact you did a couple of years ago pretty much saying the same thing, but you were proven correct in the more recent research that was retracted can you give us a quick overview of what happened. Sure that was a study actually that got retracted it was it was a study that had we had thought had taken place in basically showed that if you put Elmo stickers or stickers of characters that kids would be interested in on apples that at school. They'd be more likely to choose the apple over the cookie that they would small dry. Offers like that we could influence behavior and get kids to eat more healthily. These kinds of studies pump up in the media all the time. They're very attractive to us. We want to believe that they are true because we'd love to believe that small painless things can get us all to eat much more healthily, and to to perhaps even lose weight and not have as much of a problem with obesity, as we do all throughout the United States that study had problems because some people went back looked at the numbers, and it turned out that it didn't take place in a school as previously thought. But in a preschool or in a daycare center in a head start. If I believe those correct. So it's not surprising that we can get very small children to choose apples over cookies if you give them it almost sticker. The problem is can we get school aged kids doing the answer? Now, it turns out that a lot of studies had been done in the lab that had produced this result. And a lot of them recently in various news had were all retracted. It was just a huge set retract. From the network of journals. But this is the kind of research you hear about where if we give people smaller plates, they less if they order food when they're not hungry ahead of time. They will order less if we change how the buffet works. Are we changed the time of day when they shop? They tend to buy less calories all of these things sound great. And we love the idea because it's like, hey, I'm not having to deprive myself from not struggling and has nothing to do with going on diets. I commit these small simple changes. And I'm not going to eat as many calories, and I'm gonna lose weight and be healthy. They're all being retracted. I think the take home message from this is what we should start at the beginning. There is no free ride. If it was easy and simple for us to all eat, healthy and lose weight. We would do it. The problem is that it's hard. And especially with the way that we consume American diets today, it's very difficult to change them sometimes in ways, which allow us to eat fewer calories or eat better and lose weight and sustain that over the long term. And these simple quick fixes which make a lot of news and sell a lot of books and make from great stories and some people's careers. Don't turn out to be true. And unfortunately, in this case, it's resulted in some serious issues for for the researcher as well as as well as the lab that he worked for. But I think in general we have to acknowledge the fact that almost with almost everything and even with food. There are trade-offs. There are no quick fixes. There are no easy solutions and often the stuff that seems really sexy and novel is not nearly as true as the conservative boring moderation type stories, we'll Dr Carol you're a pediatrician. And so I am guessing that you have in the course of your career had to tell parents give parents advice about how to feed their kids. How to encourage their kids to follow a healthier diet. What do you say? What research supports it? So I think it's you got to make small steady changes part of it is trying not to snack. You know? Snacking is a problem. I think the more you eat the more eat sometimes being active can help not in the sense that exercise leads to weight loss, but with kids sometimes keeping them moving and not sitting on the couch that is often associated, you know, sitting around with a meeting because I'm I'm just bored. And so trying to change that try to change, you know, what kids eat and trying to eat more healthy diets is the same simple stuff that we would tell adults try to eat more fruits and vegetables, try to avoid processed food as much as possible not because it's full of chemicals, and because it's odd, but because food that is processed by processed. I mean, something has been done to it from ingredients before you eat, it, it makes it easy to eat more than you would otherwise like the bread makes it easy to eat wheat. Pasta makes it easy to eat flower. Those are both processed foods. You don't have to think often of just even really company produced food or industrialized food. But the more that you can stick to ingredients the more that you can get kids and families de well, balanced diets than involve lots of different foods, probably the better off, you're going to be I also advocate for trying to remove sources of added sugars in the sense that that is just empty calories and too much of our processed food in general just contain sugar because they know it will sell more. That'd sugars empty calories. It's just not necessary. It's associated with the host of issues, and it's often something that you can eliminate pretty easily without having to radically change kids diets and often by making these small changes over time. You can see decent size results. Dr caroli- promised. I would ask you about pharmaceuticals. You were talking about negative research. It's not very sexy and doesn't get published. This. Same thing can be said for pharmaceutical research. Right. Oh, absolutely. In effect, the article that I wrote on publication by Senate around antidepressants because that is such a great example to get drugs approved by the FDA pharmaceutical companies have to show that they are safe and effective, but they often just need to do that in some studies, and they only need to sort of really promote the ones where they are positive. And so some researchers actually took I think it was one hundred and four studies and what they did with actually went to the FDA websites where all the data exists. Not just the things that are published and they found that of the half or so of trials that were positive almost every single one of them was published in the peer reviewed literature, but only about half of those that were negative actually were published and so they don't have to publish the negative trials. And so we don't necessarily know how much negative date is out there will enter the positive data. But then it goes even further of the negative trials. They often change the. Outcomes to pick secondary outcomes that looked positive instead of the ones that were primary negative and that makes even some of the negative studies look positive, and sometimes they even put spin on negative results to make it sound like negative results or positive by talking about trends in the data or by citing numbers, even if they're not statistically significant. So if you take all of that together while as I said at the top about half, the studies reposited in half the size or negative. If you include the idea of we're gonna publish not are we going to cherry pick out comes in. And we're going to spin more than ninety percent of the literature looks positive, and that's how you get the sense that antidepressants massively work when again only half of the studies that we're actually done turned out to be positive. And so by moving or changing, how these things are published on and how they're published you can actually really affect how people think about them far more than the results would actually show. You mentioned say. Safety and effectiveness, and I think those are really important terms. But we don't really know what they mean. So. What do we even mean when we say safe ineffective? So f- effective means that in the actual clinical trial. They saw a different. So in an ideal perfect world situation, you see some kind of result from the drug more than placebo safe means that it did not have a significant level of harms or adverse events that occurred from it. But of course, you know, drugs can be have efficacy without affective nece, or how will they work in the real world and just because they have efficacy in a set small population. For study doesn't mean it's going to work in a large much larger population in the real world that can get us into trouble. You've been listening to Dr Aaron Carroll. He's professor of pediatrics and associate dean for research mentoring at Indiana University school of medicine. He's also director of the center for pediatric in adolescent, comparative effectiveness research his books include the bat food bible how and why to eat sinful. If you go to our website, WWW dot people's pharmacy dot com, you'll find a link to his New York Times say about the alcohol research, we also have a linked to the research itself in the Lancet after the break. We'll talk more about drug safety. How should we be talking about benefits and harms? So that we understand them better. What's the difference between relative and absolute risk? Why does it matter especially when it comes to medications like Lipitor, how can you as a consumer figure out which health risks, you really need to worry about Dr like the rest of us have a hard time unlearn things. Why is that a problem? You're listening to the people's pharmacy with Joe and Terry Graydon. If you do the health information, you get when you listen to the people's pharmacy consider subscribing to our Email newsletter. You'll get the latest health news and information on upcoming podcasts delivered to your inbox twice a week look for the link at people's pharmacy dot com. Welcome back to the people's pharmacy. I'm Joe Graydon. And I'm Terry Graydon to purchase a CD of today's show or any people sperm ac- broadcast. You can call eight hundred seven three two two three three four. Today's show is number one thousand one hundred forty one that number again, eight hundred seven thirty to twenty three thirty four you can also place the order at people's pharmacy dot com or you could download the free podcast from I tunes or from our web store. We invite you to consider writing a review today were trying to understand benefits and risks. You frequently read about a new drug that reduces the risk of some condition by twenty or thirty percent. But what does that really mean for you drug safety ineffectiveness seem clear those are the criteria for drug approval. But the. FDA has a lot of leeway on such definitions. How can you tell if a medication will really help our guest is Dr Aaron Carroll? He is professor of pediatrics and associate dean for research mentoring at Indiana University school of medicine, he's also director of the center for pediatric and adolescent, comparative effectiveness research, he's written three books a debunking medical miss. The most recent is the bad food bible how and why to eat simply Dr Carol you mentioned that safety is one of the criteria that the food and Drug administration uses before they approve a medicine, and yet all you have to do is turn on television these days, and you will see prescription drug commercials for consumers in which they mentioned side effects like cancer lymphoma, for example, or heart attacks strokes kidney disease. And sometimes they even say, including death, including death, and you go. Whoa. Wait a minute. How can that be safe? And by the way, people are having an absolutely fabulous time as all aside effects and being mentioned, I've counted six different smiles during one little voice over with side effect information. Well, that has to do with the way that we talk about or fail to talk about benefits and harms I think with respect almost everything in medicine. We just talk about them as if they are binary they exist. They do not exist versus trying to actually quantify how much benefit versus how much harm you might receive. So look, I I have all sort of colitis. I take medication Bioserve colitis. It has significant potential side effects. Have my blood drawn every three months to make sure that I don't have what's called a plastic anemia or the idea that my my bone was shutting down, and I'm not creating read one white blood cells that sounds. Horrific, but the benefits that I get from taking this drug are massive and the absolute risk of having a promise, very low. It is worth it to me for many of the drugs might see on TV it's possible that there's a quantifiable large benefit that people might achieve quantifiable small risk. Even if those things sounds scary or it could be the opposite. There could be a small benefit and a relatively large risk. You can't tell from those commercials. But that is how we've sort of mandated that those commercials exist. They have to by law state, no more benefit than what is actually true, but they have to state what harms exist, but they don't do them in ranking order, they don't quantify how many people might get them. And so they can panic you correctly or incorrectly, and they might not panic you incorrectly or correctly. Unfortunately, would just won't ever know from those types of commercials. Well, one of the techniques that commercial sometimes use t use the relative benefit when it comes to benefits because it sounds so much more impressive than than absolute benefit. So for example, some years ago there was an ad for Lipitor. I believe suggesting that there was a thirty percent reduction in heart attacks for people taking Lipitor, which if he looked at the data from the study was true. But it was because if you had one hundred people taking Lipitor for five years and two of them would have a heart attack and three of the ones taking the placebo would have a heart attack during that five years. So one person out of one hundred over five years that's a thirty percent reduction. It sounds a lot less impressive. When you put the. Numerator denominators in it absolutely does. And so this is definitely one of the ways that companies try to mislead us. But also the ways that the media can often mislead us because they will almost always cite the relative risk. So relative risk is exactly what it sounds like. It's the relative increase. So if I go from ten to twenty percent, I had ten percents before to twenty percent now I have doubled that is twice as large. If I went from twenty percent ten percent. I had a fifty percent reduction. But the absolute reduction is the difference between the two, and so I went from twenty to ten that is only a ten percent reduction, of course, ten percent reduction. Still sounds great. But fifty percent, but sounds better. But if I also go from point oh two percent, two point. Oh one percent. That is also a relative fifty percent reduction in the news story that is what you will hear v. Fifty percent reduction. It's also what you on the advertisement. Even though we only really had an absolute reduction of point, oh, one one of my favorite examples in this involves red meat where if you believe the stories that say red meat causes cancer. Even though those aren't randomized controlled trials. They will cite the fact that that they believe that processed red meat. They believe increases your lifetime risk of getting colon cancer one serving a day by eighteen percent. That sounds horrifically scary. Eighteen percent increase in getting colon cancer of our lifetime. Sounds huge. But that is a relative risk. So if we want to look at the absolute risk, we can also do that. If I went to the National Cancer website than I entered all of my data. And I'd have to pretend that I'm fifty because fifty is the youngest it goes for it. They would say that I have a lifetime cancer risk of. I think two point three percent. If I then say, I'm going to eat three extra pieces of bacon every day for the rest of my life. Which I'm not going to do my risk would go from two point three percent to two point seven percent. That is a relative risk of eighteen increase of eight relative increase of eighteen percent. But the absolute risk increase was point four percent, very low. But the eighteen percent sounds scary. The point four percent does not. And that's also if I if I choose to eat an extra three pieces of bacon every day for the rest of my life. That is not have anything to us. I said by want bacon once in a while. Which is really how they tried to scare you. But that's a massive difference between the relative risk increase, which they will often scare us with and the absolute risk increase. This happens all the time with talking about alcohol and cancer again with talking about other things we might do where we will focus on the relative risk and say it goes up by four percent by ten percent. Even by twenty percent when the absolute risk increases are very small often even less than one percent. Dr Carol our listener. I get very frustrated when they hear people talking about the dangers of alcohol the dangers of red meat the dangers of butter the dangers of this and the dangers of that. And they want to know. Well, well, Dr Carol how do I make sense of those confusing headlines where they try to scare the heck out of me based on relative risk. How can I get to that absolute risk information and not just when it comes to the risk of let's say some sort of food item. But also when it comes to medications, how can I determine how effective my medicine is going to be in the real world. Not just in some clinical trial where perhaps the data has been very carefully cherry-picked. Well, it's really hard. You can do it often by going to the actual research papers and reading them, which is what I do. But of course, I'm not expecting that everybody in the lay public is going to do that that that is what? Try to do in my Collins what I try to do in the book is try to lay out and bring the research lights that you can see it. It's hard. The media could do a much better job of trying to quantify the absolute risk changes. With all these things not just the relative risk changes. But I would also argue that we need to take a better view of risk of not only looking at one side of not just looking at harms, but also benefits. The example, I always use the number one killer in the United States have children by far is accidents car accidents, kill more children than almost anything else that we could pick. No one ever says we should not drive because so many children are killed by cars. We accept a certain number of children are going to be killed by cars because we know that this aside benefits of driving are phenomenal. And therefore we can make a logical decision that driving while increasing the absolute risk of death. And the relative IRS could death by quite a bit is worth it. We don't have that same kind of commonsense, balancing, benefits and harms in so many other things we do. Let's take the bacon example. I used a minute ago. I like bacon. It may be totally an reasonable for me to say, I'm going to take a one thousand chance that over the course of my life. I might get cancer. If I want to eat bacon every day because that's how much I love it. I'm probably taking a much lower risk because I'm not eating bacon day. But the answer is not to eat. No bacon. You have to sort of judge. What it is. We know that the sun raises your risk of skin cancer. Now, one says never go out in the sun. They say take proper precautions and think about how much doing because you don't wanna raise your risk too much. We can make balances and recognized that there's good, and there's bad and all of these things try to quantify them and measure the difference. And then determine what is the right decision for us. But that's all. Often. How news stories are not pitched and how recommendations are not done. They only focus on one side. And not the other scare you with large numbers and never make any kinds of trade offs. And I would argue that one trade off you always need to consider as a benefit is joy, you know, some things are quality of life improving, and they are more quality of life improving than the actual harm. You're accepting that is perfectly rational and reasonable. I think chocolate might fall into that category. You go perfect example for me. It's scotch. What she sticks. Dr carol. You have written that it's hard for doctors to unlearn things. Why is that a problem? So it's first of all let's knowledge, it's very hard to get human beings to change behavior. It's very hard for doctors to change behavior. There's there's some studies that say it takes fifteen years for something to sort of be proven in the medical literature, and then to finally have trickle into clinical care, but as hard as it is to get doctors to do things it's almost harder to get them to undo things part of that is because it's hard to change behavior. Part of it is because we at some level get paid to do stuff. That's not to say doctors are committing fraud or that they're trying to do extra work. It's just that. You know, they often have done things for a long time believed that they are doing good. They start to believe the causalty exists when it's just an association, they start to believe that the thing they are doing causes good. It is very hard to learn that behavior. The example, I used a reason column. Mm was talking about recommendations for how tightly we should control people's glucose levels when they're very sick. And intensive care units for a period of time. We thought we should really be on it and tightly controlled their glucose. And while we thought that the number of doctors were actually doing that increased steadily. But slowly, but then new reserved came out and said, that's a bad idea causes harm, and there's no benefit you should stop immediately. And it didn't trickle down it sort of just stayed constant because it's hard for them to unlearn behavior. I also point to a campaign called choosing wisely from the American board of internal medicine, which asks specialty groups to identify five or ten practices that their specialty. Does that all the evidence says you should not do this? I mean, basically, it's just directives don't do something. There are something like six hundred different recommendations as of this moment on the website of things that doctors should not do. Do that. We still do all of the time. It's very hard to change behavior and get doctors to stop doing stuff. How do we change that we could try to have perhaps different incentives, and in the way that we pay for things to try to get them to change, but it's very hard. And unfortunately, those actions don't do good. They don't have a quantifiable benefit they do have a quantifiable harm. They also have a very quantifiable cost and this is pure waste. It's a significant part of the healthcare system. Probably the single biggest bit of modifiable savings. We could get at and it would probably help us to do good. But it's very very hard to get physicians and not just positions but lots built, but certainly physicians to stop doing things, Dr Carol your profession. Your specialty has come under scrutiny over the last couple of decades for all those tonsillectomies that were performed back in the. Fifties and sixties, and then all those antibiotics that were prescribed for Erin factions, and then all those ear tubes. So how do we influence pediatricians to be a little more cautious? So tonsillectomies is sort of the perfect example for something that was being done that everybody thought was doing good that turned out not to him. And it was Jack Wynberg, and what later became the Dartmouth atlas that pointed all that out because he basically showed that there was huge areas of variation in the United States in the rates of tonsillectomies. There were being performed without any kinds of improvements and outcomes which proved that really didn't do any good an overtime. That's changed. When I was a kid. There was even a curious George book, which is pretty much entirely about going to hospital. Arguably about getting kids ready for tonsillectomies that don't need to happen. Antibiotics have been harder to fix the problem with antibiotics is that again, that's a good example of a mislaying of the benefits in the harms people think that antibiotics are going to cure pain and. Twenty four hours. You know, my kids and pain give me an antibiotic it never does. There's no study that's ever shown at twenty four hours will some antibiotics can cause a reduction in symptoms over the course of say two seven so that would be a benefit, but the number needed to treat is closing in on twenty on the other hand about the number needed to harm or the number of kids, you need to give an antibiotic to to give them a rash or vomiting or diarrhea is like nine. So I tell parents all the time especially when it's low risk ear infection. If I give you an antibiotic twice as likely to cause a harm as I am to give you a benefit when when portrayed in that manner. Many patients will choose not to get the antibiotic. But too often patients think there's only an upside to antibiotics, and no downside and say physicians feel the same way. All of this. I think in a lot of our conversation has been a good example of the ways that we just don't think of a whole picture when it comes to medicine everything in in health and medicine is a trade off there are harms and there are benefits and every individual decision that we make what we eat in. What medicines we take what actions are therapies, we're going to undergo should think about one of the the actual benefits and quantifiable benefits, I'm going to get what are the actual harms or quantifiable harms, I might get. And if I put them on a scale, which is more important to me, and if you take that kind of holistic outlook and think about it you're gonna make far better decisions for yourself. And we as the society would probably make far better decisions about what things we do. And do not want to do Dr Aaron Carol. Thank you so much for talking with us on the people's pharmacy today. Thank you. You've been listening to Dr Aaron Carroll professor of pediatrics and associate dean for research mentoring at Indiana University school of medicine, he's also director of the center for pediatric and adult comparative effectiveness research his research focuses on the study of information technology to improve pediatric care healthcare policy and health care reform. In addition to his scholarly activities. He writes about health research and policy for the New York Times, among other outlets. His most recent book is the bad food bible how and why to eat simply lean Seagal produced today show. How would our ski engineered Dave Graydon edits? Our interviews. The people's pharmacy is produced at the studios of North Carolina public radio W and see the people's pharmacy. Theme music is by B J Liederman to buy a CD of today's show or. Or any other people's pharmacy broadcast. You can call eight hundred seven three two two three three four. Today's show is one thousand one hundred forty one the number again, eight hundred seven thirty to twenty three thirty four online at people's pharmacy dot com when you go to our site, you can share your thoughts about today's show. How did you determine benefits and risks? If fifty people have to take medicine to help one person get a therapeutic effect. Do you think that's worth it? What about risk how do you figure out which health threats you care about in which you can ignore? Please. Share your story in the comment section for today at people's pharmacy dot com, you'll find links to Dr carols article in the New York Times. And the study we discussed you can also sign up for our free online newsletter or subscribe to the free podcast of the show. When you subscribe to the newsletter, you'll get our free guide to. Favorite home remedies in Durham, North Carolina. I'm Joe Graydon. Can't I'm Kerry grading, thanks for listening. Please join us again next. We hope you enjoyed this podcast if so please consider taking a minute to write a review on I two and thanks for listening to the people's pharmacy.

Dr Aaron Carol food and Drug administration Dr Aaron Carroll cancer Terry Graydon Indiana University school of m researcher New York Times associate dean for research director Ontari graydon United States professor of pediatrics Joe Graydon Lung cancer Elevated blood pressure gum disease university of North Carolina Tencent
Global Health and Malaria with Dr. Chandy John

Healthcare Triage Podcast

44:33 min | 4 months ago

Global Health and Malaria with Dr. Chandy John

"Welcome back to the Healthcare Trieste podcast this. PODCAST is sponsored by Indiana University School of Medicine, whose mission is to advance health in the state of Indiana beyond promoting innovation and excellence in education research patient. Care I, you school of Medicine. Leading Indiana University's first Grand Challenge, the precision health initiative with bold goals to cure multiple myeloma, triple, negative breast, cancer, childhood, Sarcoma, and prevent type, two diabetes and Alzheimer's Disease Today we. We have with US Dr Chandi John He is the Ryan White Professor of Pediatrics and the Director of the Division of Infectious Diseases in global health at Indiana University School of Medicine I should note that this episode was recorded before the pandemic started since then. Dr John's Infectious Disease Expertise helped lay the foundation for to covert related studies tactic, which is looking at how many. People in Indiana Wade. Actually be infected and discover which is looking at how immunity responses occur. After people are infected, we should also note that his research about sickle cell anemia, African children was recently published in the New England, Journal of Medicine and people might want to check that out as well Chandy. Welcome, thank you so you're the Ryan Way Professor Pediatrics. Who Is Ryan White? And what does he have to do? With Indiana Ryan White is in Indiana. Indiana heroes everyone in Indiana and the United States should know about him. Ryan White was really the first child in the United States, who was publicly known to have issued in make a secret and the reason he got into the news was because we lived. They didn't want him attending school with all the kids and he insisted on going to school. This is a very brave individual and kind of push this where a lot of. Of other people just kind of shrunk into themselves and bring it up because it's one of those things where it's like I remember I did live in Indiana at the time, but I remember it being in the news for people old enough. It was a huge huge deal I mean because up until that point. It felt like it was a pretty stigmatized disease were many people were blamed, but he seemed to be the face. If I'm remembering correctly. Correctly like the first quit I'm putting in quotes. Nobody else can see my equity. You're like innocent. Where we sort of public in this child at a big deal that everybody was so public about it. Yeah, it was a huge deal is very brave of him because he got a lot of discrimination and hate mail, and the rest of it, or you know hateful comments right to his face where he lived but he refused to sort. Back away from that and also I. Think very importantly. He also refused to be the quote unquote innocent face of it. He said that everybody who has HIV is say they should be respected. However, it was easier for the public to handle that than maybe to handle gay men who they thought of as other or or something he really did in the United States help to give face HIV that many people could relate to more And I'm the Ryan White Professor, of Pediatrics, and I always mentioned this because our whole division was supported. By an endowment for the Indiana University, Dance Marathon, and that endowment and the Indiana University dance, marathon itself were started by Ryan White's best friend from High Yeah To Stewart I believe her name was, and so she started at more than twenty five years ago and to start, it was started in honor of him, so he was supposed to start at you that fall and died before he could start the started, and she organized a dance marathons, and they've evolved this massive huge. Yeah, and if your local Indiana's a big deal with your kids and these guys are amazing, high school kids in college, kids and they raise funds for Hospital for children, but for the first many years they raised it just for our division, and so that was amazing. It's funny because I knew I knew there is money for Riley but I didn't know it was for that purpose and I. It's funny. One of those I knew Ryan White was, but when I moved here I was like. Why do they have the professorship year? Like didn't know He. INDIANA. No, it's it's amazing, and so now the funds from the Indiana. Brisy dance marathon go to the whole department of beating. US For the first twenty years it was to raise his endowment, and so when people ask me who this rich donor was, who gave the endowment that allowed us to create this amazing or build this amazing division It was It's the college kids, and and I should also very important dimension. The connection there is that writes. Doctor was Marty climate. Who is the? The founder of our division, so that was when they wanted a way to honor Ryan White and and support the things that were important to him. The sought out Dr Climate. He said supporting research in this areas is critical, and that's what they did. Well, that's great and not just completely veer directions, but you know the time what we wanted to talk about. About. Today is global health. So I like to always start by talking to you like. How did you decide? This is the area that what you wanted to be in in studying not just infectious diseases, but how they the impact, the world, not just even the United States. How'd you get here? Yeah, so there are many answers that question, but the beginning always starts with. With my parents so My parents are from India. They came here to do their residency I. always mention because this is a fact that. When they came here, they were paid to come here, so there was a doctor shortage. So when people are talking about all these terrible foreign medical grads and stuff boy. The US has relied on those foreign medical grads and. Show all the time. Yeah, it's it's a big deal and they've added a lot to the country. research wise clinical is an in every aspect of so. They came here for their residencies, and then they went back to India to work at a mission hospital and so we sort of went back and forth from the United States indie when I was a kid, but when they were there this mission hospital, its mission was to serve the poor, and so they would take us on rounds or to the hospital on a fairly regular basis because they really wanted us to be sure to see why. Why they were doing what they're doing. Their lives were very busy. They both doctors and so They were at the hospital a lot and you know kids could sort of feel like hey, why aren't you you know here with me? But we never felt that way because we saw what they were doing, and it was important, so that sense of those who have have a responsibility to serve those who have less because none of us earned what we have. It's all just you kind of like what we started with. was very strong in my parents, and they pass that onto us and so. The idea of doing something for underserved populations, and then when you think about places like India and Africa. Have you know the under served there are. An Order of magnitude, more underserved than those in most other places and so that led me into thinking. What could I do for that population? That medicine was kind of an obvious path, because my parents were doctors, and they loved what they did, and I could see its immediate impact Then you probably don't know about me, is that my big interest was in writing? It still is my first love was writing, and so I wanted to do something with writing, but I couldn't figure out a way to do that and serve that population now I? Know there are many ways you could do that, but back then I haven't. And so so when I was thinking about this, you know my mom was sort of giving me advice and she said. If you decide later that you want to be a doctor, it's going to be hard to do that where you can keep writing even if you decide to go into medicine. So that was what I did, and it was more of a pragmatic decision than a love of medicine to be totally honest, but like would. There you go. I could do something with. This wasn't sure that I really as kind of like I didn't like blood, and God's but then of course I got into it, and it's amazing like professional. Madison is just incredible and. Being part of people's lives and especially pediatrics than these kids get better and in our domain of infectious diseases. They almost always get better, and so that's very fulfilling. How did you decide to do infectious diseases? Though yeah, so it was the same thing I wanted to do something globally and historically, and to this day the biggest problems globally for sure infectious diseases and so. So why spent a couple of months at a mission hospital in Bangladesh when I was a fourth year medical student, and then in my residency added chance to do this. and I wonder if you where'd you go to Medical School University of Michigan was that was that common that people would go? No, no, it wasn't so. University Michigan was the most. Medical School I just loved it there and so was such a privileged to be there and in-state tuition was amazingly low, and it was just it was a marvelous place to be, but at the time I was there. They were not a big global health center. They are now have rectified that that problem, but back then they weren't so. It's a little unusual to do the rotation to sort of work things and then in residency. Residency I did I spent nine months. Nigeria as an absent international health, and that was really radical, because it was taking a break from residency to do this and was kind of like I. Don't know the recipe was totally happy with me for doing it, but they did support it so I give them serious credit for that. Because I'm residencies would have just said no, you're. We're not going to do that but they. They supported me and so I was doing a med peas, razzies in Nigeria the getting to the point of why did I do infectious disease? I saw all these kids with malaria was by far the number one reason for both inpatient admissions and outpatient visits at that time, if a kid had fever in pretty much any African malaria endemic region, you just treated them without a malaria. You didn't even do any other work and then. Then, if they didn't get better, you do the other workup unless there was some clinically obvious reason that was actually who standards was you gave an malaria for fever. That's how calm and it was. And at that time there were very few pediatricians doing research on malaria. In the United States, there were. There are a number of good malaria research program. Almost none in pediatrics just so hard to believe I mean. Malaria is a major. War. Back then it was like maybe number or three. There are more than a million kids every year. I mean and the statistics, and how like mosquitoes killed more people like anything else? On Evan, it's a it's an online and a lot of them are clearly children's. Why why I don't know why. It was one of those you know to be honest. I love our disappointed pediatrics, but I think we have lagged behind internal medicine and some other disciplines in terms of the global health aspect of things in some aspects. No, because if you think of vaccines, that's very much. And in pediatrics, pediatricians largely leading the way they're and they're probably the. Biggest medical in most successful medical intervention absolutely yes, so in some ways you know right there for global health for a lot of problems like this pediatricians weren't doing that and when I talk to people who like Oh is this career suicide? Nobody's out there doing this. It's kind of out there and these kinds of responses. I would get from some people. There are definitely people that are supportive. So I think that pediatrics took a little while to kind of grow into wanting to do more in the research space of global people were thinking more about volunteer things and stuff like that, which is important, but even when? When we talk about even I think clinically go. I see I see a fair number. Medical students even see a fair number residents who say they want to do it and spend a month or go, but it feels almost as if it's vacation destination. He Yeah, not now like dedicating lot. Which is why I'm always impressed by. You know people who are like I'm going. It's a hard road like you had make it. No one was saying we have a plan. That says he'll do a a month here and then nine months here. That's how you get to to do that so I mean especially I think. Years ago it probably took a fair amount of effort to carve out those kinds of careers yeah. I mean it was much less much more of the road. Less traveled within pediatrics I I'll happily say things are vastly different now and I feel like pediatrics is in many ways leading the way in education in terms of those very things you talked about that global health work should never be medical tourism that there should be a. Mutually beneficial partnership in every case, I think they're really outstanding pediatricians at every level education and research rent doing now, but back then kind of across the board. It was just it was hard to do so You had to be pretty. determined that this was what you wanted to, but that was the one thing that I will say is I was determined and and. I if I like if there is somebody listening to this, who's starting or whatever I think you know like I'm not the smartest person on block. I'm not the most you know like the have the brightest ideas but I work hard and I was willing to persevere, and I think those things matter more than anything, especially global health because you just have to. Just have to like there's a lot of things that go get a lot of things. Do not succeed. You Know Rachel Freeman, who is one of our? We've had a props. My my fellow when she declared that this is what she wanted to doing entered our fellowship in a completely different path, but this is where I want to. Make my life, I remember not trying to talk her out of it, but being like I have literally no idea what muscle to flex to make any of this work. You'll be entirely on your own and the story. She's telling me about what she had to do to get stuff done. In Kenya where I think most of her work is one of the things I focus on how hard it is to get people healthcare in the United States of America, which is a pretty wealthy research country, and it's so difficult I can't even fathom how hard it must be not only get healthy, but research done in some of these settings I mean the number of extra steps and things that you have to do it. It's impressive. Anyone engages with it. Let alone succeeds, and it's such testament I think to how people are willing to work. Yeah, I think. Rachel's like the poster child for dedication and perseverance in the face of obstacles because she knew what she's doing was in is important and and I think that's just it. Is that you if you're in that setting and you have a research type of mindset, you see the possibilities for the difference that research can make in those populations, and that along with really great partnerships with incredibly smart and engaged people in the country. who kind of provide mentorship in how to do this and. And what you can contribute I always say if everything is being contributed by your partners overseas, and there's really no room for you so you should have something to contribute as well, but she got an I got so much mentorship with the people outside are like. Hey, this is what you should focus on. This is what's important. Here's how to do it in this setting, but then you work with them, and you see the difference it can make an I will say you know like the people that are working there the people that she works at people that I work with could have jobs anyway. and they work in what can often be an extremely. Frustrating and difficult system day in and day out whereas we're going there, but we have the support of a US university, and so it's a real tribute to them that this work gets done. Because ultimately, that's what matters is that people on the ground have the know-how and expertise to work with you to get it done, and they're willing to just keep going I. Think I remember now when Rachel was on the program, we talked about empathic general, but but in university has a long standing relationship with. My correct entire hospital systems yeah, yeah, Kanye Ghia talk briefly about it. Just people that haven't heard about absolutely so amp hat stands for the APP academic model to provide access to healthcare, and I should say up front I came here from the University of Minnesota so I work together with path, but I'm not really You know one of the Path physicians or researchers or educators, but I decided to move to Indiana University in part, because path is here because it's such an extraordinary program and I think what set set apart from every other program. I believe every other academic program in the. The United States is two things. One is that the decision was made right at the beginning to focus on access to healthcare who it is not primarily a research group. Amazing research gets done with it at like Rachel's cameras and and many others, but that is not be that is a goal. The primary goal is providing access to healthcare, so that is unusual, and so it's a university using its knowledge in partnership with another university more university to work on access to healthcare, and then the other thing is Indiana University. When right when this started, it was an academic model, so it was not just Indiana University and No, you know universities are wonder places to work, but they're kind of territorial. People want to the glory to come to a you, so they started from the beginning. This is a model and any university that wants to be a partner if they meet these criteria for partnership, and so multiple other universities I won't. Remember them all, but Brown Mount Sinai do University of Toronto University Massachusetts. Many others are part of this consortium so together they're working to provide access to healthcare, and then within that they degrade research and education programs. It really is just amazing. One of those things that the more you hear about it, it's just it's stunning. I mean just what they've accomplished and. You know not that great appeared at time is just amazing. It's incredible. I mean the the this whole model to provide access to healthcare. They're now working with the government of Kenya which wants to provide universal healthcare to help model how that could happen, and how could work within the areas where they work? There's a huge amount of work in HIV, and they've revolutionized care of. Of HIV they're now working in chronic diseases cancer center. I mean it's really a a most extraordinary program and great things for me as I try to recruit people within our Pediatric Infectious Diseases Division. An Path is a huge draw because work in that setting is just you know it the opportunities to do great things or so I think didn't draw from at the medical school. Medical since all the time where this is. What drew them? Which is amazing? Yeah, it's fantastic. Let's shift course a little bit I WanNa talk about malaria, 'cause it's other things where again worldwide such a massive problem. It's not the United States. I'd be plenty of people. Don't even know what it what it is. So what is malaria so malaria as a parasitic infection that is spread by mosquitoes it. Can't be transmitted person to person in general I can get it from blood treasurers, but it's really ninety nine point, nine nine nine percent of it is spread by mosquitoes which take infected blood from one person and injected into another, and this parasite goes into your liver, and then escapes from your liver into your bloodstream, and when it gets into your bloodstream, it causes symptoms, so you can get a very high fevers from it, and if you get really sick from it, you can go into coma. Severe Anemia, you can get very bad respiratory distress, a bunch of things, and if you don't get treatment, you can die from it, and it is still one of the leading killers of death in children, which is just again just stunning I mean just the because it's. Can't we worry about all these things that are so dangerous and it's still one of the top five I'm sure. Yeah, I think it is although I like one very happy thing, and in the course of my career is seeing. The progress has been made in malaria, I wish I could say it was all do. Not But but you know bednets and better drugs and other things have reduced the death toll estimate when I started working two million deaths a year. Pretty rough estimates. It's now down to under five hundred thousand, so it's even if it was a million. It's a massive decrease in the number of so, why is it such a big problem in other countries, so many reasons if I talk about Africa specifically It turns out that the African malaria, mosquito, vector or vectors are much more efficient transmission than ones that occur elsewhere, so we have an awfully mosquitoes in the United States, and there was malaria here up till night the nineteen forties, so it was a problem here. interesting sidelights. CDC was started as the office of War Research to combat malaria don't. But it has its genesis in the word. Combat Malaria Yeah. So so CDC has a long history with malaria, but The African vectors are much more efficient transmission, so that's one big problem. and then access to health care is a huge issues of people are living in rural areas more often occurs in rural areas most of Africa's still rural so That's a problem, and then they can't get to the care they need to in time. and things that worked here, so we had malaria here and it's gone. wising gone in Africa will it's a long. Long story but a number of things that worked here are harder to implement across the sub continent of Africa than they were in the United States and a lot of it has to do with a public health system that's able to detect cases and then treat those cases in anyone near those cases kind of across the board so many different factors, but those are some of them, but I would see the biggest thing probably as the public health system in access to healthcare so when it's the public health. Health system is it. Is it prevention from getting bitten? Is it not getting rid of mosquitoes enough? Is it that we don't treat people fast enough? And therefore that allows a mosquito transmitted from, or is it all? It's all of those so in the US. When they were getting down to the end, anybody who had malaria got to the House of that preside malaria, the treat everyone there they might even do spraying of the areas. It's very intense campaign at the end to get you know. Get things down to zero. Zero, so that's difficult to do. Especially in rural areas in Africa, to that same extent and then if you're in a rural area, if the healthcare facilities are far and few between, then people may not come in anti. It's quite late in the meantime. Not only. Is it bad for them? Because it's caused severe disease, but they've had a chance to transmit it to more people, so many of these things together see, said bednets I mean. How much is it? Is it nighttime when a real problem? Yes. It's a female off mosquito that. and She Bites at night so What bednets themselves are not that effective, but insecticide-treated bednets very effective, and they're effective, because the mosquitoes land on them and die They don't get a chance to bite the child, so they going a transfer transmit, and they don't get a chance to transmit to others, either so it's not just the prevention of biting the child. It's also killing. The mosquito on contact is prevented medication I mean. Is there a way I? AM asking totally out of ignorance. Yes, so the next time you come to Kenya Uganda. Aaron inviting you now. Many times just trying to find the time and then. You will take malaria prophylaxis I guess if you want. Now even around elder at their mosquitoes. You Good Nairobi. There's just really there's I mean. There are mosquitos, but there's really no transmission of of malaria. The guidelines will save. You're going solely tonight, roby. You don't need take perplexes, but pretty much. If you're going to Uganda Kenya, you take prophylaxis to prevent malaria medications to malaria, and they're quite effective. They're not one hundred percent, but anywhere from eighty to ninety five percent effective every time I go to Uganda or Kenya I, take a medicine and There have been campaigns to have this in Africa. And there are there is actually so the difficulty is in many places. The whole populations expose e have kids going on this medicine for years and sometimes it's a you can get away with weekly medicine, but that's as long as you can do. Some of them are daily, and so it's tough to. It's tough to do that in a population, but there are W recommended regimens for places that. That have seasonal malaria that during the malaria season, the youngest children will take chemo-prevention in pregnancy. Women are more susceptible to malaria, and it's bad for them and for their fetus, and so there's also recommendations that all pregnant women Milan daycares. Get Chemo friendship, so there are these targeted populations again. Clearly, we radically for the most part in the united. States was that because we just treated so much just. killed it off while there are many different factors, one was as good housing and kind of drainage of swamped areas and things like that, so kind of good general public health measures and better health overall tend to decrease rates of malaria pretty substantially themselves that just by itself. Then there were campaign so a lot of things we wouldn't do now like spring with Paris Green and DDT. Who's your pretty toxic and they do it and sprayed everywhere, but it works. So if you get it down if you get it down to a certain level, then that can sort of take zero I mean many years in Africa. There are some more focused spraying efforts, but they're so much higher than we were that. You'RE NOT GONNA get it down to zero like it works for a while, and then the b-actor comes right back, so the spraying campaigns toxic have been had their effect, and then it was the public health component of if somebody comes with malaria. Go out to that house. Treat the people. So what are your research interests? Overlap in malaria, so three major areas one is to figure out why kids get severe malaria. WHY CERTAIN CHILDREN GET Severe Malaria? Because some kids get very bad Blair hospitals in some kids don't and why you know. Can we prevent severe malaria? another is that a major complication of severe malaria is Noor Developmental impairments of kids, not thinking as well functioning. Functioning as well as they could be, so, why does that happen? And what can we do to prevent that and that so those are sort of on the sick child with malaria side, and then and in Uganda, and then in Kenya, the work focuses on an area, very low transmission. That's gotten lower over the twenty years. We've been there and my original work. On trying to understand how immunity changes as your exposure to malaria goes down, we're still looking at that because we're interested in. If you wanted to vaccinate a population like that where there's not much malaria, how would a vaccine work versus where the areas where it's traditionally tried which have a lot of malaria, because it may be quite different, your immune system may respond differently to the vaccine but now we're in addition to working on that. We're working on while we've gotten malaria down so low. How can we actually get to know local transmission because it's really low, but then periodically they'll be outbreak, so it seems to me like we have to get to to to know malaria the area, but the complicated part of that is that the areas surrounding it have much higher transmission. Transmission so you have to do something. That's both effective and sustainable, and there's not an easy answer to that, but I feel personal commitment I in the one area of Kenya. I've been working there for nineteen years now. and we've just watched this trend with malaria and I felt like okay. The time has come for us to work with the Ministry of Health. Really get it down to zero. Zero. There's one other area that I work in a again back in Uganda which is infections, the kids with sickle cell disease, and the Genesis of this is actually that the reason we have sickle cell. Disease is because of malaria hemoglobin, A. S. or one copy of the sickle gene is highly protected against severe malaria. How is that? Yeah, it's amazing so well I get the genetic. Trait with exists, but how does it work? Yeah, so there are many different reasons why it's positive that it works which have a fair amount of evidence for them, so the having hemoglobin as sickles yourselves a little bit when the parasite goes in and so it makes the red cell less hospitable to the parasite may get cleared by the spleen. It seems to decrease oxygen concentration in the cell, and to that's less good for the parasite, and it helps decrease parasite burden and decrease parasite load, and there are a number of other factors like nitric oxide. It seemed to be altered by. Sal that has hemoglobin in it, and so they never were almost never get sick. Cling crises, but they do have alterations in their cells that make them less hospitable to the parasites, and so I mean is the reason we have sickle cell disease today because of malaria it is, there's no the it's incontrovertible evidence, because if you look at where malaria historically has been and where sickles, all diseases including outside of Africa it's a perfect overlap. That's just so may yes is sickle cell disease exists because Hemoglobin A.. A. S. or sickle cell trait was protective protected against malaria, and what we we've done. These studies of severe malaria that is telling you about, and we get group of control children from the same neighborhoods or households as the kids with severe malaria to look at what how they think, and how is that different from kids with severe malaria? That's how we get our our population norm and only looked at the prevalence of hemoglobin, A. Astor sickle cell trait in the control kids versus the kids with severe malaria. I think eighteen percent and the control kids and two percent and the kids with severe. We rediscovered protective effect that's I. Mean that's just so I mean it's just so amazing to see such a concrete example of how natural yeah, natural selection at work, so what happened though is of course that if you I mean and places where the most malaria, there's almost twenty percent prevalence globally ass. If you do the math that would mean roughly four percent, ish of kids would be would have been s s, and historically these kids get a diagnosis. And they died before the age of five from infection or complications, other complications of sickle cell disease, and so I was working in these malaria democ areas. Caisley kids with sickle cell and not know what to. To do with them and you know like they were pretty neglected population in Uganda. When I started working there there was a very foresighted doctor named Professor Christopher Undo Gua who, in nineteen, sixty nine started sickle cell clinic. I'm Malaga Hospitals? That's more than fifty years ago now and it was one of the first clinic of its kind, and so he identified that this population was a population in need and got them good clinical services, and so the kids who are attending that clink did better than kids in general, but still there were many things that were available here. That were not available in Uganda, because the research had been done or. Or whatever, and so, that was what drew me to looking about population was it was such a such neglected population, and there were simple things that could be done. That were not being done yet. How did you choose to work in Uganda boy? That is a long story that will shorten by saying that I was working in Kenya for many years before I started working in Uganda. and I had an opportunity to do a slightly longer version of the story when I was in Nigeria. I worked at a mission hospital there with a doctor named Cindy Howard is a pediatrician. One of my kind of life influences cindy after she had finished her work. Work in Nigeria started working in Uganda, so she had some connections there when I would meet her, she'd say should meet these people that are working Uganda, some of their amazing. There was one resident I work. He was incredible. I was at Case Western at the time. This resident incredible resident one research award. He decided to want to come out to case Western because Case Western was doing TB. Studies and Uganda said they were well known university there. I met him and he's a I was trying to highland hospitalized. Malaria study in Kenya wasn't working out for complicated reasons they said well. We have islands in Uganda. Why don't you come work there? So I did? we switched the study to Uganda and then an opportunity came up between residency and fellowship I decided that I've been on the fast track do long, and I wanted some time to write and travel and do some global health work and so I worked as a PDD docking to pick you up again for those that are listening like. It's always good to go out in the real world and be away from academics for little bit. Bit. I felt like they gave me some really good. Like critical thinking. I doc on the on site skills. I spent time in Laos helping setting pediatric residency in Laos and when I came back the person who sent me out their car and Olmos who is an amazing global health. Person said we should talk to Michael Boivin. He's going out there to look at cognition in these kids with malaria. You talked just to you know like. Let him know what your experience there was, and what he should be triggered, so he was in Michigan, I was in Michigan. We talk. And then he came to case Western instead like we should study cognitive impairment in these kids with severe malaria, and at that time was like now. He just needs to get rid of malaria. Let's not you know like I don't think we should do that, but he veered and convince me like his his line, which was absolutely true was, but you're still seeing these kids severe, so it's not gone yet. Yet! Are you going to do something for them? So I said yes. You're right and so together. We put in this grant and I decided to do it in Uganda. Because my hospital based connections were much stronger in Uganda. And that's how I ended up in. You KINDA. How do you go about setting up these things I mean they sound I can't even I don't know what muscle to flex. How do you do it yet? So it was learning experience for me. My Mentor Case Western. I went to Case Western for fellowship. Precede on! On their Jim Zara was real master at this, he worked in Papua New Guinea in and we worked together. In Kenya, and it's all about knowing the people locally and areas, they identify important the first study for example been working this highland area for a long time as I told you and it start because Kenyan colleague of Jim's while these highland areas, they keep getting outbreaks. Do you think that could have anything to do with them? Losing Immunity Jim said will you're starting as as a fallow and you know like you're interested in learning. Learning lab stuff. Why don't you think about how you can look at immunity? These populations you can work on this study with me and John Uma was our Kenyan colleagues name, so it starts with identifying what's important to your local collaborators? You know the situation far better than you do. Sometimes there are requests for applications. Nih and you have to see if it fits what they want. And then I think it's identifying good people. It's very important to me to always talk about The people I work with in Uganda and Kenya in. The? Baba? Poke is my main clinical EPI research collaborator Paul Bungee Rana is by primary neuropsychologist claburn. He actually got are his PhD with our project. And now he's a pin is own on several. That's granted Richard Rose. Collaborator and we have some up and coming collaborators ruth nause is our hematology collaborate so these are amazing people, and they all have different strengths, and so as a question of we like each other. We like the work that the others do. How can we work together to address an important problem? Israel local people yeah. They're all bracket Democrats in the United States. No, no, they're all based at mccarey university, and then in in Kenya my main collaborator is. Is Georgia Yodo who works with Kanye Medical Research Institute and with a university there Jaramogi Oginga Odinga, university and so he and I been working for many years in his strength was actually genetics, but now he's doing more epidemiology work, but in all cases we enjoy the work together, and we've always been able to figure out roles for each of us, and for the people like for me, junior faculty or post, docs or PhD students and For them the same thing on the Ugandan side. Like how can this work so it helps both groups, and it leads to the bigger goal so I I was like dimensioned them. Just because I think that people think like you go out there and you do these projects, but you don't know it's the people they're doing the project and you are doing your part of it. That can be useful to them in the project. What are you most excited by right now? Where do you what things are coming down the pike that you have the most optimism for a very excited about the reduction in cases and deaths of malaria, and I think it can go further there are vaccines in development. There's this possibility of genetic modified Mosquitos. or mosquitoes with other organisms in them that make them. Them less hospitable to to the parasite, there are campaigns of mass treatment that can reduce the population burn overall, even things we've used for a while like bednets spraying still have their place, and so there are many different ways in which we can very actively work to reduce malaria, so I think that we're going to keep seeing reductions and I'm I'm optimistic about that. That, the flip side of that is that we've stalled the last two or three years, and so I'm also worried like drug-resistance like malaria. They can big die from the fifties in seventies, drug-resistance came at the tail end of the sixties and Seventies. It just skyrocketed again and so I feel like I feel like the pressure is on for us to be aggressive about interventions. Interventions and research now because we have this opportunity to keep driving down, but if we get satisfied, it will come back in in blaze. Can you any more than once oh? Yes, okay, so then. How would a vaccine work? That's a great question because we don't have a great vaccine for malaria, so designing a vaccine for a parasite, which is much more complex or Bacteria or virus is very difficult. There's never been a successful human parasite vaccine. The vaccine is that we have for malaria have worked, but it's been like maybe thirty percent efficacy. There are some vaccines right now. That seemed to show in very small trials, maybe more efficacy, but you have to give him intravenously. That's obviously not a great thing for you know mass deployment. The trick with a vaccine is to end up. Generating response. It's better than the parasite itself generates, and it's been really hard to ensure its and yeah, and then things at work here and people that are completely malaria naive may not work as well in kids who are not totally malaria Ni- because they've been prime, maybe have immune tolerance, whatever, so it is quite tricky thing, but the goal with the vaccine is actually improve on. On the natural response, so the wouldn't get repeated episodes. So this is going to be totally naive again, but what about better? Just mosquito repellent? Yeah, well, that's being worked on. It's not naive at all. There's big studies looking at spatial repellents and other ways of using it has to be something. Probably, that's not something that people are going to be on themselves because they just won't. Is that I was going to that biggest issue. I'm speaking from experience like. People in the United States, spray them say yeah. Yeah. People don't want to do it and so something that would repel, but doesn't require the person to do it every day I. think that's the key. repellents are being used as well so there's a lot of things I mean it's really an exciting time to malaria because he's been a lot of success and is kind of promised success, but there's also the specter of like. You Take Your foot off the pedal a minute and suddenly are. Just I I mean I know upset, even multiple times in this conversation, but it's one of those things where I don't think people understand how big a deal it is. Yeah, it's a huge deal and what we've shown like, so you always wonder like what is your contribution like any of our work? Really Reduce Malaria because that wasn't what we were focusing on implementation. Implementation we researched, but what I can say is that some of the work in Uganda show that there's this big cost of child neurodevelopment from Severe Malaria, and we actually are doing a study right now we're. We're taking the three cohorts. We enrolled to study this and following them anywhere from five to twenty years after the had the episode, said now we can. Can See things like. Is there a health related quality of life caused? Is there an economic cost? Is there a cost academic achievement? Kids who had are they less likely to go to college, and we have a control group that's from the same households or neighborhoods, so they're pretty good control group for all these other factors might affect that so we're trying to. To define that for the very long term bet, even like as far as two years out. We shown a cost here and so there's a cost in terms of debts, but there's probably a societal cost that's as substantial when you look at all the survivors, and what happens to their brains. The other thing that I'm very excited about is sickle cell disease because. We, did this studied yeah of of using hydroxy Rio which is used for kids here in sickle cell with sickle cell disease and we've. There was no reason to believe it wouldn't be effective. It's very effectively reducing complications and probably prolonging life. There's enough data to show that yet, but it's likely because it produces end organ damage, but there was reason to believe that maybe it would be harmful in. In terms of making kids more at risk for severe malaria for severe infection, and so the long, the short of it is the study that we did it was first placebo controlled Rcti Roxie and kids in Africa and it showed that and it was done with our with Baba told you about in our collaborate Russell where his pediatric hematologist. That was another thing I wanted to study. Sickle cell disease, but couldn't study it without an expert in sickle cell disease research, we had the experts in clinical disease, and Uganda, but we needed the research expert, which was Russell, where and so Russell joined us, and we did. The study together showed hydroxy was not only effective, but safe and so that's actually one of the more satisfying. These ever been involved with my usual stuff is like what happens with immunity, or what happens renders not an immediate translational step, but the Ministry of Health has actually already proved hydroxyurea for using sickles these it was a cancer drug before to cancer drug and now it's expanding the guidelines and we're there trying to get subsidized Roxy Rea-, so kids who need it can get it so I feel like within five years. Most kids with cycles of these. Will be on hydroxy. It can have side effects, so you need. Do it right like if it's just given out like water, no one's falling. These things can be bad, but that's another thing that Bob and a colleague. Here at a you are studying together. How can you do this so that it's effective, but also safe follow up in resource, poor areas, but it's exciting to see it being used. Be Used at all when we started. And now it is so I, feel like and we're doing a study on zinc to see if it can prevent infection kids with sickle cell disease so. We, yes, so it turns out that people can't see like a mega face. The United States so this is so interesting to me. Because the few things I think one is that there were studies done in the United States that suggested that there was an effect. on preventing infection and a large effect, and then there was another study, but they were all done in adults or older children, and then there was another study that was dining India, that showed it had a large effect as well I'm talking like fifty to eighty percent reduction. I'm like I think really it's I would be thrilled. Don't get me wrong I. Want to see yeah, so so and the reason why? Why it may work, is that when kids with sickle cell disease bone crises is all stuff I learned from my colleague. Nutrition Syracuse. She sort of brought this up because I'm not a nutrition expert and I I like parenthetically. That's the joy of academics as you collaborate with super sharp people, and they give you new ideas that are like really inspiring. She found this data that I never knew about we were. Were writing a book chapter ever and it was like. Don't write book taxes terrible, but we writing books. I agree to, and like she found this data on zinc, being productive in sickle cell disease, more looking at it turns out in bone in these basically crises that they have when the cell cycle and they they clot off circulation to the bones, the bones released zinc, and it goes out into the bloodstream. Bloodstream and kids with sickle cell disease often have some renal impairment, and so it sort of escapes in the urine as well even without renal impairment it can be excreted in the urine, and so there are studies that show that kids with sickle cell disease, low zinc plasma levels, but there's reasons to believe that their actual whole bodies glowed is even lower than what you see in their plasma, so they are. Zinc deficient for a reason, and this is why zinc might okay, so that makes a lot of sense versus just the whole like. Just that someone. But but the great thing about it is if it works, we have Ecuador's. We don't sure there's a couple studies showing that it does. They were an older kids. Maybe the younger kids don't have as much zinc deficiency but if it worked, it's almost completely nontoxic. Yeah, and it's easy to take and it's cheap as dirt already got it for less than a sent a pill, so if it worked here be an intervention that you could give. It's like it. You wouldn't require any monitoring and if he also just take the pill, and it's like three bucks a year going on now. Yes, going on now. We want to have you back. Yeah, exactly. Hopefully it won't be to say like didn't work now. Sean we take negative results but. Healthcare Trash podcast, is sponsored by the School of Medicine whose mission is to advance health state of Indiana beyond by promoting innovation and excellence in education, research and patient care. They're also leading universities first grand challenge, the precision health initiative with bold goals to cure multiple myeloma, triple, negative breast, cancer, and Childhood Sarcoma and prevent type, two diabetes and Alzheimer's disease.

malaria United States Uganda Kenya Africa Indiana Indiana University School of M Indiana University Ryan White multiple myeloma HIV India New England Ryan Way Professor Pediatrics Dr John fevers Alzheimer's Disease Medical School Nigeria Journal of Medicine
#1261 - Peter Hotez

The Joe Rogan Experience

1:59:49 hr | 1 year ago

#1261 - Peter Hotez

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Well, listen folks, ZipRecruiter can be tried out for free. What? Yes, they're so confident you're gonna love it and use it all the time. Just go to ZipRecruiter dot com slash Rogan. And you can try ZipRecruiter for free. That's ZipRecruiter dot com slash R. O G A N ZipRecruiter dot com slash Rogan. Ziprecruiter, the smartest way to hire. Smartest bitch. He know what else? A smart quip quips my toothbrush. It's they made a better mouse trap. They did they took the electric toothbrush. And they said what can we do with this thing? Well, first of all they made it sleeker. It's like the size of sharpy perfect size brush and its gentle enough on your sensitive gums with their their vibrations. They're sensitive sonic vibrations. Because sometimes people brush too hard. And some electric toothbrushes are actually too abrasive. Their toothbrush also has a built in two minute timer. 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If you go to get quip dot com slash Rogan right now, you can get your first repeal repeal refill pack for free with a quip electric toothbrush. That's get your first refill pack for free at get quip dot com slash Rogan. GATT Q U IP dot com slash Rogan and last but not least we're brought to you by perfect Kito. If you're an Kito genyk dieting, a lot of people are on the Kito diet print plan these days because first of all it's a great way to maintain energy. When your body starts burning off fat. You don't get that late afternoon crash. I go back and forth with it right now. Not an Akita genyk state. But I very often am and even when I'm not I love perfect Keita's products. A lot of their stuff is fantastic delicious. They made they make nut butter that is one of my. Favorites. It's really healthy. It's it's a great Goto of just hungry. And I'm looking for something. I will just scoop that stuff out with a spoon and eat it or you can take some of their bars. They have some fantastic Kito bars almond butter, brownie, salted, caramel lemon. Poppy seed, those are some of the new ones you could take that stuff. You put their MAC Damian nut butter on top of that. And you can either put it in the freezer, just eat it. They also have executives key tones. That are excellent executives key tones are very effective when you're going through that transition as well because when you're making the transition between your body burning off carbohydrates and key tones a lot of times you like, oh, it's like you get what they call the Kito flu coma. Gone. Oh, you get tired. Well, executives key tones can mitigate a lot of that stuff. And and perfect Kito has excellent exoti- key tones. You can try all of the perfect Kito products that I use. And if you go to their website and check it out they have a list of all the stuff that I use and they're offering listeners twenty percent off of their purchase. So go to perfect Kito dot com slash Rogan to find my favorites and enter the code Rogin at checkout. That's perfect Kito Kito spelled K T O P E R F E C T K E T, O dot com slash Rogin and enter the code Rogin at checkout. Okay. Okay. Oh, my guest today. Ladies and gentlemen, is he is a very famous man in the world of medicine. He was on my television show that I did for sci-fi many many years ago, and I talked about infectious diseases and all sorts of stuff. And when I asked him to come on the show. That's what a initially wanted to talk about. But then we. I found out through the fact that he was talking about coming on the show that a lot of people were very interested in his take on vaccines, people that are pro vaccine and people that are anti vaccine who accused him of being shell. And anyway, I enjoy him. I enjoy talking to them. And I think we we went into vaccines quite a bit. And he's explained why he believes that vaccines do not cause autism. What the actual cause vaccines are how it can be identified. We also talked a lot about infectious diseases, including a lot of infectious diseases that are extremely common in Paris is extremely common in the United States that I didn't even know about his name is Dr Peter hotels. He's the professor in dean of the national school of Tropical Medicine at Baylor. College of medicine and his great guy and really enjoyed talking to him. So please give it up for Dr Peter hotels. The Joe Rogan experience. Oh, rob your podcast by. And we'll live Corser. How are you could see again, I'm thrilled to be here. Thanks this man. Thanks for having. I know I should tell you before we get started. I did not know when I asked you to come back on that you were heavily involved in this whole vaccine debate what I wanted to have you on to talk about as tropical diseases because I remember when we did that fi show. You explain to me that some ungodly percentage of people that live in Trump climates are infected by parasites. That's right. Well, my day job is developing vaccines for tropical diseases. We developed a vaccine no one else will make because for the world's poorest people. So we called them tropical diseases, but there really are diseases of poverty, the vaccine issue, the the advocacy issue around vaccines and autism is kind of a new thing that I got drawn into just because I'm a parent of an adult daughter with autism. And I make vaccine so it was a natural that I'd get drawn into it. Yeah. So when I. I said that you were going to come on. Then I got inundated by people that are, you know, the vaccine thing is such a polarizing issue. That's awful. And so many people seem to think they absolutely know what causes what especially when it comes to something like autism, which is a huge issue in this country to huge issue around the world. And it didn't use to seem to be the question is was that because it was undiagnosed was that because it just it's more prevalent today. What do you think what is your take on? I don't think we really know. One thing's for sure, we're diagnosing people with autism. Who we diagnosed as something else in the past. You know, whether it was, you know, really horrible diagnosis, we'd use pejorative terms like mental retardation. What's jamie? To start the clock was off. Oh, okay. Sorry sorry to start again. No. No. No. It's okay. He was just saying he was just telling me that there are clock screwed up because of the daylight savings. Right. Sorry. Totally unrelated to all countries clock screwed up because they yeah. Right. So so we don't know we don't well one thing is clear that the number of diagnoses is going up. But part of that is because what we used to call preordained things like mental retardation now get thrown into the autism category. The other thing too it. Absolutely. No. Well, you know now we call it as part of the autism spectrum. We also because autism often has a lot of associated intellectual disabilities. Not always. But sometimes the other is that positive is that based on aptitude tests like how do you? How do they decide? How do they decide? What's autism? They they have a list of diagnostic cat. Gore. But it's not it's not like you could test someone if they test positive for a disease. That's right. That's right. Well, although it, you know, one of the interesting side pieces to this is, you know, the there's a group of people out there who self identify themselves as the autistic, and they get very resentful or hurt when they're called a disease or disorder in because they say, well, we're not an epidemic. We're we're a person, and they that it's part of this whole neuro diversity movement. Which is quite interesting. Neuro diversity move. Right. They say their neuro diverse that they, you know, maybe think differently from others and they respond differently than others, but they're not quote, abnormal. And and I think they have a good argument. I heard a crazy argument wants when someone that was so the so the point is that it's you know, the the impairment like Rachel my daughter. It's not so much autism that thwarts her, you know, ability to have partners or to. Have a meaningful career. It's the fact that she has profound in her case, profound intellectual disability that goes along with it. I forgot what I was gonna say. So when when they say that people have a there's a spectrum, right and some people who are have an incredible abilities. That's right them incredible mathematical abilities musical abilities language abilities. And then some people do not some people have legitimate issues. Yeah. With Rachel's case, my daughter, she has a pretty good verbal I q eighty ninety but she has a very low performance Cuban forty. She can't do. Simple math. She can't count money. Fortunately, Goodwill Industries came to her rescue in our rescue. And now, she works two hours a day sorting clothes, and and that's been really meaningful for her to get a paycheck, even it was minimum wage. Yeah. Right. Do something. Yeah. Right. Pardon feel part of the mix. That's huge. That's huge for everyone wraps Lutely. Absolutely. But so there's no. Oh, there's it's not like you test positive for syphilis or you can test positive for the flu. Right. Although now, you know, as I say, so that's why I don't like using those those terms because it it puts people on the autism spectrum as though they have a disease, which I don't like to do. But. Well, you know, now, we know there are ninety nine genes are linked to autism. But why is it about thing to say they have a disorder if it's just a disorder people have disorders right act? Well, you know, a lot of the individuals in that that self identify themselves autistic don't like to think of themselves as a disorder. They like to think of the cells is different different monotonous -sarily as a disorder. Right. But that doesn't help us when we're trying to discuss it does. Yeah. It gets very it's it's hard gets hard to talk about. And they're they're trying to stop you from talking about it in a certain fashion, which is actually accurate, right? When they have an issue. There is an issue to say there's no issue is kind of ridiculous. It's I mean, there's a reason why so many people are so concerned about autism and vaccines and just autism in general rights environmental pollution, grabs. Will they like to do is? They like to make the distinction between autism that nerve diversity thing. And actually having intellectual disabilities that go along with it. Okay. Maybe it's a bit of semantics also, but they feel strongly about right now, if we don't know what causes autism. We do we do. Well, we're getting there very closely. So we've now there is a very important paper produced written by group at the broad institute. Harvard MIT, which is one of the premier genetics genomics organizations in the country. And they've now identified ninety nine genes, it's a it's a huge team of scientists not only at the broad, including piece, I deserve Baylor. College of medicine ninety nine genes involved in autism all involved in early fetal development, early brain development in the first and second trimester pregnancy. So now, we're starting to really get our arms around what autism is. And that's one of the things. I talk about in the book. I mean, we we have learned so much in the last couple of years about autism. How it begins early fetal development well before kids ever, see accedes. And that's one of the reasons I save. Scenes did not cause Rachel's autism vaccines. Don't cause autism because autism is already underway in early early brain development is it possible that some people have this tendency towards autism. And it's exacerbated by vaccine, I don't think so I think what what happens is the sequence of events happens during pregnancy. But the full clinical expression of autism often doesn't happen till eighteen or nineteen months of age. Rachel, for instance, wasn't actually diagnosed till nineteen months of age, and there's some fabulous. Studies now showing that that clinical expression of autism actually coincides with a big increase in the in the volume of the brain, you can actually show on cereal magnetic magnetic resonance imaging serial Emory, how the brain starts to the brain volume starts to increase, and that's very important because parents will often remember, oh, my kid got vaccinated on eighteen. Months of age or or fifteen months of age and to link the two, but now you can go back to six months of agents. The studies done the university of North Carolina Chapel Hill showing so that you could do an MRI at six months of age and they can predict now with they say with ninety percent accuracy, which of the kids will go on to develop autism. And then you could take what are they saying? What what are they saying, you they can see are you have to go? We can go into detail in the paper, but they can see certain things on signatures on MRI that tell them that this kid is going to go on to develop. Okay. So in fact, there is a way to test positive for autism. Then with this serial. That's what they think right now, we have the ninety nine, gene. So we can even take it back further by doing what's called Holik some sequencing sequencing all the DNA all the express DNA of an individual in. Rachel's case, we did that and we actually find the mutation in gene controlling neuronal connections. Which makes a lot of sense. If you think moment autism. Yeah. Of course. So so there is a way to to show whether children will be more likely to develop autism. And there's there is a way to to look at their brain through FM aura at a very early age. And and also do the in do genetic sequence. So it's not simply a matter of how they perform on cognitive test. That's right. That's right. We're getting much better at getting arms around the diagnosis. Why do you think there's so many people that have these anecdotal stories of their child getting vaccinated, especially large doses of vaccines when they hit them with like ten in a row? And then all the sudden or measles, measles mumps and rebellious, the one that gets repeated over and over again, that's the one that made my child have autism. I've heard that so many times, and I've heard it from friends from friends that have children that have autism. They had a child their child got the measles mumps rebellious shot and then immediately. There was a very distinct change in the child's behavior. Well, no question when you get the measles, mumps, rubella vaccine, many times kids cry and things like that. And then. Autism will then begin sometime between the first and second year of life. So it's logical to want to connect the two. But now, we know it's not even plausible because we know that if you go back to that MRI at six months of age or go back prenatally, we can even determine which kids are gonna go onto autism. So even. Even in that complimenting get complimenting. It are massive epidemiologic. Studies done over one million kids that in fact, a new paper was just released this week showing that kids who get the MR get the vaccine are no more likely to get autism than kids who don't who. Don't get the vaccine and the converse is also true kids on the autism. Spectrum are no more likely to have gotten the Emma more vaccine kids, not on the autism spectrum. Okay. So so it's the combination of that those big studies have over one million kids together with knowing what autism is completely rules out the possibility. Right. So these genes excuse me, the the issue with these genes, and then the ability to scan the brain with the cereal MRI, and so you can tell which children have the propensity is it possible that children have all these issues and then do not get autism or do one hundred percent. Of those children with those issues get autism. That's a good question. I don't know. I'm vaccine scientists, I'm you know, the not about the the well well biologist, but I'm the vaccine scientists who twos really tried to deep dive in autism doing research on the book versus human development. Right. Right. Okay. So. So what you're saying though, is that if a child does not have these mutations and doesn't have these issues that are present in during cereal MRI that they will not go on to develop autism is that far as we can tell we can tell so children without those issues who get vaccinated have have no problems, which most children have no problems. Right. Yeah. I mean, the, you know, we've learned a lot about the the risk of vaccines and the numbers are extrordinary. I mean, the risk of severe adverse event happening after getting a vaccine is roughly on the order of one in a million between between one in a million and one in ten billion. So and I found an internet report wants is a delight likelihood of getting struck by lightning as one in seven hundred thousand. So it's, you know, the likelihood of having a severe event after a vaccine is your odds are better of getting struck by lightning than when you say severe. What do you mean by? Severe event the well, the there's actually a table that's put out by the national vaccine compensation act that includes shoulder injury. That's one encephalitis and says older entering. Yeah. That's actually from the actual injection yet. Put getting injecting it in the wrong place. Oh, so it goes into the joint or something. Yeah. Yeah. Is that common? No, no. So there there have been issues children have adverse effects and reactions to vaccines. What do you attribute those two? But one one in a million, I think, you know, in some cases, biological variability. I think some cases introvertedly if it's a live virus vaccine like the measles, mumps rubella vaccine, and you have an underlying immune deficiency that wasn't picked up before the virus can replicate better. But very rare things like that. Right. So as far as you know, children who are healthy who get. Vaccine is it's not biologically possible for them to develop these traits these mutations in the genes, and these issues that you see president as best we can tell right now that seems to be the case right as best you could tell right now. It's a great thing to say I but for people that are on the outside. Like, what does that mean? I'm not a doctor. I'm not smart enough to understand what Dr Who has saying. What does he say what we can tell can we tell? So here's what we can tell no studies of one million children that there's no link between vaccines and autism. That's number one. And and so let me purse holidays let me let me purchase hope to into bits. So there's there's the studies on one million childrens showing the vaccines do not cause autism. That's part one. The second is. And then I'll do a deeper diamond each of them. The second part shows not only is there massive evidence that there's no link between vaccines and autism. There's no plausibility because we know so much about autism. Help begins in pregnancy. And so let's go back to the first part. The first part is studies in over one million children one of the things that the vaccine lobby does is they played this game of what I was not really a game. But what what they see what they do is play this kind of thing vaccine whack-a-mole because at first they alleged was the mar- vaccine, and that came out out of the study that was published in the Lancet nineteen Ninety-Eight, then another group came along and said, no, no, no, we didn't mean the MR vaccine, we meant the Mirasol preservative that used to be in vaccine and the scientific community not only debunked the Amar linked. They debunked the Amira selling then the anti vaccine lobby came along and said, no, no, we didn't mean that. We're spacing vaccines too close together. Then they changed to around again saying now, it's. The album or aluminum and vaccine so and then each time the scientific community responds with massive epidemiologic. Studies showed just absolutely none of those things are true. And do you think that it's just when you look at say if there's one in a million that has an issue with this, and they're not autism. So what whatever those issues are that they hear these stories and these stories do accumulate because there's three hundred plus million people in this country and over ten twenty years of one million you develop a significant history of cases, where children did have issues with vaccines. So these people hear about these stories and people are terrified, obviously, you're I have children become very over protective of children who worry a lot. Right. And then you also don't know why do they get so many shots all in a row? Like, why does a baby get ten shots in a day? It seems crazy. Well, they don't get ten shots in a day. Most. Most of the vaccines are now combined. So for instance, in one vaccine, we can vaccinate against Syria. Pertussis tetanus polio, HAMAs influenza type b which is terrible cause of meningitis and some cases now even hepatitis a one shot is protected hoop of all combine, and there's all sorts of study showing that it's safe to combine them in. And it's fantastic. Now, you can vaccinate with one shot against six diseases. So and these are life threatening disease, right? So the only concern is the child's immune system when they're embargoed with this one. So a lot of times it causes. It'd be tired or they're get sick. Apprentice siemian system is not bombarded. That's another kind of its misnomer that the Arab misunderstanding that's put up by the anti vaccine lobby. Remember the child's gut the intestines and the respiratory tree. Is is this. Oregon's of antigen presentation. A baby on average is exposed to hundreds of new antigens every day. So the idea that you're going to quote, overwhelm the immune system with vaccine against six diseases. Just doesn't make any sense again. This is all phony baloney stuff put out by the anti vaccine lobby. Let's let's be clear the anti vaccine lobby owns the internet right now. They've what does that mean? What that means is they've got they've put out now by some estimates five hundred anti vaccine websites. So that every time you put the word vaccine into a search engine. Whether it's the yahu who Google you're going to get anti vaccine misinformation. That's number one second. We know. Now, it's amplified social media like Facebook other forms of social media, so third, you know, look at the Amazon site. I mean, it's it's incredible. So my book this book, the good news is I think right now, it's the highest rated pro vaccine book on. Amazon the bad news is overall ranked about twenty because there's nineteen other phoney bologna anti vaccine books. So the Amazon is the biggest purveyor now of anti vaccine books. Wait, it gets even worse than you also have. Now, they've come politicized. They have political action committees in multiple states lobbying state legislators about fall with plying them with false information about what backs vaccines do. So. And and the problem is we don't have a robust system of pro vaccine advocacy to counter it, so we don't really hear as much as we need to from the federal government from the CDC from the search surgeon general so unfortunately in this country that defensive vaccines false to a handful of academics like myself, and you know, I'm an academic. I wrote a book what what chance do I stand against this major media empire that why do you think? Exists. Why do you think there is this major media empire? That's against vaccines. That's a great question. What's the motive? What's the motivation number one? And number two. Where's the money coming from right, right? There's real money behind this millions of dollars behind this to put out phony, documentaries and phony books. What's a good phone documentary? Two point two. Well, I'm a little reluctant to say because they're Sola Tisch's event. And and you know, I don't have the means to defend a lawsuit, and that's out there these documents. I'd usually don't mean specific showrooms or I understand these documentaries. What do you think their motivation is do you think they earnestly believe that vaccines do cause harm vaccines do crowds? I. Autism. I don't know. I mean is there some kind of other agenda that they have. I mean, we do know in some cases that the some elements of the anti vaccine lobby are promoting phony autism therapies, right? They're doing terrible things. Like this thing called MS, which are bleach Animas watts. Yeah. Bleach giving bleach animals to get you into chil- the children bleach bleach because their cleansing the immune system cleansing them of toxin, though. It's really awful and they're doing key Latian therapy, which is very dangerous. Does that that's where they they claim? You know kids are overdose with toxic metal. So they give chemical that actually can kill the metal. But it can kill it your calcium and put you into a fatal arrhythmias. Well, they're also who is doing this key Latian therapy or you can Google. Okay. It's or whatever interesting or these doctors like sun some cases there doctors, unfortunately, or other. Their health professionals. And what is I mean? I'm sure you've studied the evidence. There's no evidence. And then and then they're doing hyperbaric therapy, which is really bad so hyperbaric therapies bad. Well for doesn't do anything for autism. That's okay. But it's it's good for recovering from injuries and yet under certain selected cer-. But who knows what who knows what it's doing to a young kid? Right. I mean, so you shouldn't be doing that the then the other then that's one. So how much of this is being driven by financial motivation, peddling these phony autism there. I can't say my sense is that's not the big piece of this. You know, there's also some reports now Russian bots and trolls that are amplifying this and sewing political instability Ryan tree. But again, you add that all up the phony autism therapies, the Russian bots and troll. The my mind that really doesn't get our arms around the big driver this thing. So I think we really need some good investigative journalists to look into this. Well, do you think that they're? Has some sort of a concerted effort, or do you think it's just a bunch of people that really believe that vaccines do cause autism? They don't truly understand the science, and they haven't talked to someone like you. And maybe they have this idea that cemented in their mind. And they're not willing to look at it, objectively and look at the full spectrum of possibilities and look at the science behind what you guys are saying because in their head they've been saying vaccines cause autism. They've been saying it for so long. Once someone gets that in their connected to that. It's very difficult for them shift gears view, people have a really hard time not being married to an idea. Yeah. No, I agree. And you know, when I talked a nice spend a lot of time going around the country giving what are called grand rounds lectures to hospitals and medical schools pediatric grand rounds. So I've had the chance to talk to a lot of pediatricians, nurses, and nurse practitioner. Even and more and more than a few. Parents my impression is most of the parents are. Who who are called to be so called vaccine hesitant as the word of the day are not really deeply dug it, I mean, you can you can have a conversation with them and explain to them like we're talking now in a very, you know, nontechnical way, you know, the evidence showing vaccines don't cause autism in the lack of plausibility given that that it begins in pregnancy, and they'll vaccinate their kids. There is another percentage. Not I don't know what the percentage is whether ten fifteen percent that are deeply dug in and our holy invested in this conspiracy theory that the that the government is in cahoots with the pharmaceutical companies and blahdy blahdy, blah. And then if you try to talk them out of it, they just think you're part of the conspiracy. So it's sort of not no win approach there. But but most parents you can have a good conversation with most parents. Yeah, it's not necessarily even most parents, right? I mean, what you're dealing with this these people that maybe they're into a bunch of different alternate therapies, a bunch of different kinds. Cleansing. And you know, there's a lot of that nonsense that you find online where I mean, look there's legitimate. But, but I guess my point sorry, please. No. But I guess my point is parents don't get the chance because they're so inundated with phony anti vaccine information that they do Google. Yeah. Or whatever, you know, whatever search they do. So what do you think should be done? Should there be a pro vaccine documentary that makes sense? I thank thanks for that question. I think there's three things that need to be done. I think first of all some of this anti vaccine media empire needs to be dismantled dismantle dismantled. And then. Say whether the wrong, right? Like shouldn't. I mean, it seems like there should be some sort of a debate. Right. Like, if there's someone who's saying that there's some evidence vaccines caused debate you're saying there's no evidence of vaccines caused debate excuse me that vaccine causes autism. And you're saying there's no evidence that vaccines cross autism. There should be a debate where some sort of a like some sort of a monitored conversation where you can have you versus someone else and break this down. Yeah. But that that has that's too short too. Because you know, then it gives some false legitimacy to anti vaccine side. It's like debating, the smoking causes cancer. Yeah. But doesn't isn't there? Already a problem. I mean, it seems like if there's this many if you do Google search, and you're just overwhelmed right with anti it seems like the fight has already been lost. If that's the case. That's right. So giving them legitimacy let's not necessarily giving them the legitimacy. It's giving them. If you give you rather a forum to dismiss. Their legitimacy. Yeah. I mean, I think you know, part of what has to be done is. I mean, and this gets into all sorts of first amendment issues, and I'm not a lawyer. But, you know, the the idea that Amazon now is putting out all of these phony books, and and phony documentaries now, they're just a distributor, right? They don't have to go over every book that they sell the fine to buy. Maybe they should. I mean, not mind toothcomb. But maybe there should be some screening, maybe Amazon may be Facebook should all be hiring chief scientific officers to you know, putting some stops on dissemination of information because it's harming children, right? I mean, I mean, this is the reason I get passionate about it. The reason I actually wrote the book is kind of interesting. I it actually happened before all of these big measles outbreaks that we've been having. Yeah. I'm I noticed that in Texas. There was where my laboratories at Texas children's hospital and Baylor College of medicine we noticed that. There was a steep increase in the number of kids whose parents were. Opting them out of getting vaccinated to the point. Where in Texas. We have over six sixty thousand kids not getting their vaccines in the state of Texas. And those are the ones we know about we don't know anything about the three hundred and twenty five thousand home schooled kids, so we probably over one hundred thousand kids and not getting vaccinated all because of this misinformation campaign, and I was really troubled by the fact that there was no response to it. And that was drove me to write the book. So the point is now Texas is very vulnerable to measles outbreaks, and I say measles more than the others because that's the most highly contagious disease. What what's the danger of child getting measles? So is there any benefit to a child getting measles in terms of their immune system? No, there's no benefit, and that's one of the phony books. They put out melanie's marvelous measles. I mean, it's it's awful. So what did they say in that book, they say, build your immune system? It does not it does not. It's remember after. So let's go back a little bit smallpox was awry. Medicated in the late nineteen seventies through vaccination one smallpox was radically radically. Measles was arguably the single leading killer of children, globally, two point six million children died every year measles because it causes measles pneumonia measles. And Steph Elias talk about permanent neurologic injury. That's a bad actor measles and deftness at all and then through global vaccination campaigns. We brought it down by the year two thousand to about half a million kids dying. And then the Gates Foundation put up seven hundred and fifty million dollars to create the gobbly lines. Global lines for vaccines immunization we've brought it down now to one hundred thousand. But now measles was coming back. Europe's disaster right now, we've got eighty thousand measles cases in two thousand eighteen in Europe. And now it's coming back to the US. And so my worry is this meet the anti vaccine media empire is started out as a fringe group. But now, it's really affecting public health allowing a deadly disease. Measles to come back. Do you think if there's some sort of definitive evidence that shows to the general public like you could you could show it to them like this is what causes autism? We've narrowed it down to these genes. And it it has nothing to do with vaccines. If you give these vaccines to people without these genes, there is no way, they're gonna get autism. They get autism specifically because of these variations in their chain. You just you just summarize the book, right? But I mean, we name more than a book. It does disturb me when I hear about all these kids getting measles. And and not just measles. But means in some places polio's made a resurgence. Well, polio. You know, we're down to about three three countries. Still have transmission awhile type polio, its Nigeria Pakistan Afghanistan, so hopefully, we're getting arms around polio. But measles is now come roaring back with a vengeance. Having people contract polio outside of those areas. I mean, those are the areas where it's every now. And then some cases pop we've got some. Wherever in this could get onto a whole 'nother topic wherever there's collapse and health systems infrastructure during two from war, political instability, these diseases can come back they can come back and the people that are vulnerable children that are not immunized. That's right. And when you're immunized, you're not vulnerable. That's right. Yeah. This is it's a really confusing thing for people because on the outside. They people always want to think that big pharma. I've said some terrible things about big pharma. And the reason being is painkillers because painkillers antidepressants and there's SS arise which over prescribed and the painkiller. One kills me because I know people directly that have been addicted to these goddamn things and the doctors are passing them out like candy. So people look at big farm as being oh, these in the monsters that push this. They're also the people that give you things that save people's lives. Yeah. There's a lot going on there. Yeah. I'm the I'm the big defender of of the big pharmaceutical companies. I mean, one of the things that the empty. The insults that anti vaccine her let me as they say Michelle for industry, they say are secretly taking money from Merck and Jackson Smith, lots all crap. I don't take penny from them. And I am it's it's not even how do you just buy from the university pay by the university? And some of that some of my salaries offset by not grants from nonprofit foundations, then this is the national. Right. And then they say I'm secretly making millions of dollars for vaccines for hookworm and schistosomiasis and shots you deal with all that money. I my wife says if only that were the case, right? These are diseases of the poorest of the Pearl never make a penny on these disease. In fact, you know, one of the frustrations I have with the big pharmaceutical companies is we've gotten a lot made a lot of progress of their vaccines. We've gone all the way from discovery through early face, process development and manufacturing, and I and defiling with the FDA investigational new drug applications, but we're kind of stuck at phase one phase two clinical trials because we don't have the big pharma money to take us all the way to licenser. So I've had a lot of meetings with the big pharmaceutical companies to see if they can partner with us and so far that hasn't happened. So is has there ever been any discussion or any interest in creating some sort of a compelling documentary? That's pro vaccination that can counter all these things because there's there's quite a few health. Related documentaries that I know are horse shit because I've talked to actual real scientists and clinical researchers at say like all these things are saying wrong. And this is why the wrong in this. You could show this the wrong. And then when someone says, hey, I saw this documentary. It says it all you should eat. His toast can say listen, man. You got to go here and watch this. And they'll show you why that's nonsense. Right. Is there anything like that? Right now discussion not right now there are some discussions, but we're a long way off from that. And the problem is the anti vaccine documentaries are being destroyed widely distributed widely sold and those people that are talking about it. Here's the other problem whenever I talked to someone about who's been doing this a lot lately or talk to someone about something that passionate about what books you read on it. It was like, well, I saw this documentary. Well, very, and there are books and factors. Nineteen ninety nine hundred and a head of mine. Books that are written by actual researchers people that have spent decades in labs understanding what's going on. You don't really, you know, you don't get a lot of that from the people that are anti anything. Right. That's that's why I wrote the new book, it's a very confusing thing for parents because you're scared. You know, you have this little tiny baby that you love more than anything in this world. And then the doctor say, hey, we've got this round of vaccines common. And you're just terrified that you're going to do something to your child can turn your child into someone who's compromised. Yeah. And and the point is problems these diseases are back now. And so they're the urgency to vaccinate is now more than ever. I mean, remember right now, look what's going on in Vancouver Washington right now, we're the measles. Outbreak is underway. The ones who who are greatest risk are infants under the age twelve months, not yet old enough to get their vaccine. So that if you're a parent right now living in Vancouver, Washington, you're terrified terrified about. Taking your baby out, the WalMart or pathetic. Vaccine because their. Right. So now the diseases coming back because the older kids are catching it, and the and the anti vaccine lobby uses terms like personal liberties and medical freedom. Will we're the personal liberties of this parent now who terrified the taker in her infant anti vaccine lobby. No, I know that Robert Kennedy, jR, is he's a he's a big one. He's a big one. And he seems like a very intelligent guy her could he not be aware of the science behind this. What is he getting wrong? What what he's getting wrong is just about everything, you know, he's formed an organization called children's health defense and and start he had a press conference about it. I think it was September October of last year. It is probably one of the best organized antibac- seen groups out there. Now, he's doing other things other than vaccines. He's doing a lot of things about environmental health and things like that. I don't know any part of that business. I've only followed what the what he does with vaccines. But it's all it's all nonsense. Why is he doing this about? Axiom. Don't know. What's I mean, you have to ask what what's his motivation? Would he be a guy that you would want to have a debate with or have a discussion with? But again, I mean, I I'm I'm uncomfortable with the idea of a debate. Because it's like, it's like debating, I dunno. It's like debating holocaust denier, whether the holocaust exist. I mean, not that this rise. I understand what you're saying. But if you're again, I want to bring this up if you're complaining, there's nineteen books ahead of yours that are anti vaccine books. You've already lost the battle like it's time to regroup and maybe regrouping would be confronting someone with actual scientific information. Mean you are a real doctor your guy who actually studied this. And you're a man who understands the science your legitimate academic. You could you could actually put dent in this with a real conversation. Yeah. Potentially potentially. I mean, what would he be able to say like what is his take on it? Well, remember, he's he's an attorney, and he's he's very clever. Great and right now, he knows how our presumably knows how to do argument. In court and one of my scientific, right? But do you think that he wants to deceive people or do you think that maybe he's just incorrect in his accumulation of data? Yeah. I can't say what his motivation is. But his his his information is is highly misleading. Now, what else is you say the lobby is this an organized thing. Good question. I mean, we again, we need somebody who really wants to do a deep dive in this kind of dissect out the pieces. Yeah. To understand. But it's it's impressive. What you've got out there in terms of the hundreds of websites, and the amplification on social media and everything else is it are there just one or two or three groups behind it. Or is it a random collection of organizations that that needs to be looked up that does need to know what what do you think is causing autism and in your personal estimate? Do you think that it is a? That there's a rise in the factors that are causing autism. Or do you think that it's a a rise in the understanding of these variables that contribute to it that you could diagnose people within that before the previously undiagnosed? So I I think most of it is that that we're just diagnosing it more including individuals in the autism category that we didn't before. And by the way, the numbers are about to go up even more because we're getting better at diagnosing girls and women with autism. Which is also quite interesting used to say was ten to one voice girls. And now, we know there are a lot more girls and women on the autism spectrum. It just that they're usually more verbal, and they can camouflage it better, but they have very high rates of Comber biddies like obsessive compulsive disorder attention deficit hyperactivity disorder a lot of the teenage girls with eating disorders. Now, they're finding could actually be on the autism spectrum. So the numbers are about to go up again. I mean, that's just an example. I mean is I guess what you really? Trying to get at is beyond that is there is there a bona fide increase beyond the number of diagnosis. And and that one I'm still not sure about the I wrote an article about early onset gender dysphoric being connected to young girls autism, right? Yeah. There's a disproportionate number of girls with gender dis foia who turned out to be also test. I've heard that as well. Yeah. That's actually. So it's really fascinating about now. Unfortunate fastening at the there. There's there's a nice paper by very good environmental scientists in Philander gin who used to be a Mount Sinai now, I think he's a Boston College now, and he publishes about five or six chemicals in the environment. Which if you're exposed to for long periods of time during early pregnancy. Your child will be born with some features that resemble autism. Do you know what those chemicals all I have to? Remember? I talked about him in the book on one of them is deputy. Coat felpro acc- acid, which is a psychiatric medicine used as a mood stabilizer or an antidepressant. So prolong use of depakote during pregnancy has been linked to. Something that resembles autism common Medicaid. It's a common medication. But now that we know this information, we don't use it anymore. So one of the things that I've been saying to, you know, people like Bobby Kennedy and everything else if you really want if you really think there's some environmental linked to autism. We've got a list of at least six chemicals during early exposure in pregnancy that are probably causing mutations and things like that that are leading to autism wire weight, and why isn't anybody looking into that? It's just crazy. I mean, so all the focus on goes into vaccines, and it kind of sucks all the action out of the room. So that, you know, really understanding the search for autism gets the later in some cases doesn't get pursued at all or the other thing that happens in many state, legislatures and things like that the focus is so much about vaccines that we don't talk about what autism parents really need. I mean, what do I need for Rachel? We need, you know, employment counseling and help we need mental health counseling. What do we do after? We're. On Rachel right now is living with us. I'm I turned sixty my wife is, you know, fifty eight what happens to us ten fifteen twenty years from now, there's no roadmap. Whereas the so so all of that gets shunted aside because of these phony baloney anti vaccine argument, that's what I get angry. That's when I start to realize these guys and addition to affecting public health are actually hurting autism families as well. Well, that makes sense. I mean, and I can completely understand why the subset you especially as scientists. Now when you're talking about these various chemicals that you think do contribute to or possibly cause autism. Maybe we should really concentrate on that and publish something about this. Is this something that is there an article that people can go to says something about this is I talk about it in the book, and the could fine opened up the book, I could provide it for you. Is there anything that people can read online about this without going to your book? Probably, you know, one of the problems that we face in this country is that we put a lot of scientific articles behind paywall is a real source of frustration for me, they do that. Well, one of the one of the things that I've done now is I'm one of the I founded a an open access journal call the public library science neglected tropical diseases. So that anybody with a computer, you know, an internet connection and a printer can download the articles. Free of charge. And we need more of that does great. But right now, if someone wants to find out these chemicals, they have to buy your book, or by some sort of access to scientific papers. I'm not sure what that particular paper. Whether it's behind a paywall or not on them. Look, I mean besides measles. What other diseases are more prevalent now because people not vaccinating the kids once there's three diseases that I worry about the most actually for well, whooping, cough is another one. So that that's one, but the other one I worried about is the flu vaccine kids aren't getting their flu vaccine last year and the twenty thousand flu epidemic a hundred and fifty unvaccinated kids died of influenza despite the recommendation of accident because he knew enlighten me on this. Because what I've been told is that sometimes they get the flu vaccine wrong. So you can get vaccinated. But it doesn't doesn't protect you for the strain of flu that everybody's getting while. So that's again, something that was heavily an idea of. Heavily pushed by the anti vaccine lobby. Here's the story. You're right lashed, partially right? Last year. The there was not. Perfect match between the between the the virus and the vaccine the killed virus and the vaccine and the wild type flu strain that was out there. But it was good enough to prevent you from dying. And it was good enough to would likely prevent you from being hospitalized. So would affect even if you did get that's right because it was enough cross protection. So that it would it would mitigate the symptoms. That's confusing to people because of they have the flu they say, oh, well that it didn't work. That's right. But it did because it prevents you from getting sick and dying. And and again that was that was a message that never really got out and twenty let's talk about someone like me who's a healthy person. I've had the flu before, but I don't usually get a flu shot. That's crazy. You should especially now. Especially now as you're getting older was because flu is one of the leading is probably the single leading infectious disease killer of of adults in the United States. But every time I've had it. It's really been like just a couple of days out. I rest. Well, you know, fluid you got lucky my friends what it is. Well, you know, sure taking care. Let's so if you look at the eighty thousand adults who died in the influenza epidemic of twenty eight teen in the United States. You're right. A lot of them had underlying things like diabetes, or or noncommunicable, cardiovascular disease or underlying respiratory disease. Maybe they were smokers. But that there's still, but they're still thought which are still thousands of individuals who are perfectly healthy died of influenza that we know. So you don't get your flu vaccine, you're taking terrible. And why not why I mean what what are you risking by getting the flu vacs? I'm busy, bro. You know, what you, you know, where I, you know, where I get my vaccinations. Walgreens, even better we have a big grocery store chain in Texas big supermarket called HEB to get it up the nose again, I get it. I get the injection right in the pharmacist the far all of my vaccines. I've gotten for the last few years have been given by the pharmacist interesting. So couldn't be easier. Are you have you ever gotten the flu since the beginning the vaccine every year? Well, you know, I've gotten I've gotten sick with a coal like a like a sore throat and feeling crummy was that a mild case of flu. I can't really tell. Okay. But you've never gotten sick right after you got a vaccine some people do right know, some get a vaccine, and then they have an adverse reaction to sometimes, you know, after getting your vaccine, you can get some soreness, and you can feel maybe a slight fever or few hours or a day. But usually, it's your fine. What is that? What does that? What does that fever? Why why are you getting a fever because the vaccine is stimulating the immune system and stimulating the inflammatory system. So even though you feel like you're getting sick because the vaccine is actually good for your immune system that that's right? And you're not really sick. I mean, it's nothing like is nearly as bad as getting the flu the other vaccine now that you're getting up there you have to start considering the shingles vaccine shingle wrecks, and that's a that's a great vaccine at hurts though for a couple of days. Do you take care of your immune system and other ways? Do you take probiotics? Are you cautious about your diet? I'm not as cautious about my diet is I should be. I'm a junk food Hollick. Actually, that seems like a terrible thing for your. It is a terrible thing for my health and something my wife is working on it. But that's seems ridiculous for someone who works with health. Yeah. Yeah. Some sometimes man, I just get it. Right. How often? What how often how often do I steal a bag of chips or something like garbage? I don't know hopefully, not every day. But maybe a couple of times a week. That's what Rachel my my daughter with autism. That's like our thing is to go to the it's called the burger joint door to shake shack to get to get a cheeseburger, we'll sticks sneak some fries. So so you live in large. We call it like that mouth pleasure. So much willing to sacrifice a little bit. Yeah. I, you know, I, you know, I have to concede. That's the case. Well, there's I mean, I have to tell you. But there's a large body of data that connects poor diet to a host of disease. That seems like a crazy decision for guy in your line of work. There you go sometimes the. Sometimes the it's not all brain. It's it it's something else. But I mean, if you ate healthy food. I mean, the thing is your body starts craving healthy food you start feeling. No, no question. No question about it. Do you take vitamins? I don't take Adams real. Wow. Think they do. I don't think there needed because most and the American and the American up hold up hold up. You don't think they're needed where you're junk food. Well, hopefully, I'm not only eating junk food. But you know, there's a large body of clinical research on the efficacy of vitamins, especially vitamins, div items. I have taken vitamin d for periods better recommendation of my internist in what about essential fatty acids, which are great for your brain fish oil, all these different things. That are fantastic. I'm not gonna I'm not gonna argue with you. Got it had gotten you. Got it over me. Yeah. Listen to, but it would you would have a much better argument. You're making my life. Stay here. Taking care of yourself. A hundred percent said, but she still needs. Bet you still need your vaccines. I'm sure you do but vaccines aren't going to prevent cancer. No, that's true. Right. And there's a lot of diseases or diabetes or vascular disease. A lot of these diseases are connected directly to die. Yeah. Yeah. Come on and other lifestyle change. Yeah. Senate sedentary life. I tried to go on the treadmill for thirty minutes. Try. I do actually I'm pretty good about thirty minutes every morning for an actual walk. It's more interest. I did that too. So I I don't know. But I deal with thirty minutes on the treadmill in the warning. And then I and my I take a long while because my wife in the evening good. But it, you know, the the thing that knocks the crap out of the travel. Yes, I find that very frustrating because you know, exercise, and then you eat you don't eat. Well, well, you don't control the diet as well. So that's. Well, I have a solution to that and eat well and exercise those those are solutions to that. Just do it. You know, I treat it like, I'm brushing my teeth. I brush my teeth every day. Yeah. I exercise everyday to. Yeah. So when I travel I don't have an option when I land I go to the gym, this is how goes I land. I get my hotel room. I put my short. Yeah. I did that too. I do that too. See only if you have to do it. If say, this is just what gets done this is how you do it. Yeah. I try to be really compulsive about them. So yeah, I have it written. Now. I know what I'm going to do especially if the great if the hotel is a good, Jim the whole, you know, if they have weights and a bunch of all run outside if you don't have you run. Yeah to. Yeah. Not very well. But no, yeah. Yeah. We're gonna get you healthy, buddy. Yeah. Can't be pushing only chemicals in injectable forms to facilitate health fair enough. Yeah. Or not chemicals vaccine samsar. What's in them? What I mean? It's some sort of chemical now. No other antigens, right? They're they're fluid macromolecules. What's liquids typically would be saline or salt water? Now, what is missing from today's vaccine protocol if anything in terms of diseases, we should be vaccinating for but nothing. Yeah. There certainly are. You know, one of them is a big big problem on young infants especially premature infants called RSP respiratory since issue virus infection. What does that come from it? It's you know, it's a respiratory virus that peeks around the same time that flew does. So it's a very severe respiratory illness. So this is again, one of those vaccines. That's not a. Moneymaker? So the Bill of Melinda Gates Foundation is trying to provide grants for supporting that one that that's a good one. And then they're all the diseases that affect poor people both in developing countries, even among the poor and the United States this book. That's that's the next one called marble health the next one. So this is not released yet. This is out this actually this actually preceded the, oh, that's one. Now this book is all about poor people and infectious diseases and the rise of these infectious diseases, even in the United States. That's right. So, you know, when we think about so I, you know, led this big campaign to raise awareness of somebody. Call neglected tropical diseases Ren TD's. These are the most common afflictions of people living in poverty. I call them the most important disease you've never heard of their diseases like schistosomiasis and shower Gus disease leash Manassas and have been. Voting my life to seeing if we could develop vaccines for those diseases in the nonprofit sector because the big pharmaceutical companies just don't see just aren't going to take these on. So we're trying to do it in the nonprofit sector, but the this book, the blue marble health book came out of some number crunching that I did using data from the World Health Organization or something called the institute for health metrics and evaluation, which is based in Seattle Washington that found something very surprising. And that is most of the world's poverty related. Diseases are not necessarily in the poorest, most devastated countries of Africa being Democratic Republic of Congo Central African Republic, they're there, but on the numbers basis. Most of these poverty related diseases are actually in the G twenty economies the twenty wealthiest economies together with Nigeria which is not that g twenty country, but has an economy bigger than the bottom. Three or four. So that was pretty amazing amazing for me to find that out because you know, at first I didn't believe the numbers because I said, well, how could it be if they're poverty related diseases? Why are the in the twenty wealthiest economies? And then I realized that it's among the poor living in wealthy countries. So the poorest of the rich today now account for most of the world's poverty related diseases. And what what's the cause of this? So why why the link with poverty, so that's a great Kosovo one of the things I do in the book is I ask that. Well, what is it about poverty that's making susceptible? I don't think we really know. I mean, clearly in some cases, if you live in poor dilapidated housing without window screens things like mosquitoes and kissing bugs and sandflies can get inside the house or if you look in poor neighborhoods like interrupt Houston. You see a lot of environmental degradation or around the neighborhood, obviously discarded tires. I read it. He's gypped I- mosquito or standing water. But I think what what what did tire still does. So. Yeah. So one of the best habitats for the mosquito that transmits Dangi Zeka and chicken ganja and yellow fever are discarded tires. That's what they love. So this, you know, if you go into poor neighborhoods. You'll see a lot of tired dumping, for instance. And that's those are habitats for the that eighties. Gypped I'm skeet including here in southern cali-. So is it when the water gets in the tax write a little bit of a lot. That's exactly yeah. I, you know, I moved into a house once in Encino down the street from here, in fact, and no in lived in the house for about a year and a half two years and the pool had not been taken care of. And I went out into the pool and it was green and there were schools of mosquito skied oh heaven heaven's. Yeah. So strange, so so, yeah, absolutely go into poor neighborhoods, abandoned swim. Pools things like that. That's that's where we're getting a number of these diseases. We don't have very many mosquitoes in southern California. I mean, it's really kind of amazing in that regard. Well, it depends. So, you know, some counties where they do aggressive spraying and things like that you won't, but many counties, you probably probably some of the poorer counties poor districts, you still do, but I mean in terms of the way it is on the east coast. Like, I grew up in Boston and in the summertime, you just have fucking mosquitoes. Everywhere you just can't get away from them. And then I've been to Alaska, which is the craziest place of ever been to in my life in terms of mosquitoes. Right. Have you been I haven't been to Alaska, Larry, you get out of your car, and they attack you like a horde of birds because you only get one month of the year exam have they're super aggressive, and they're they're also very large the big problems along the Gulf Coast of the US. We have that aged I- mosquito. And that's why I've got so worried about Zeke virus hitting the Gulf Coast of the US. Yeah. Mosquitoes and other countries obviously contain. Malaria. I mean, we've been very fortunate that that's never made it over here. Well, no, we we used to have malaria used to be widespread in the United States. Both the one that was a real killer disease called Faust Cipro malaria on the Gulf Coast and even up into Illinois in the higher river valley. We had a lot of malaria when was us. I've I've asked in the eighteen hundreds. In fact, there's a whole there's a book written by dickens when he visited the United States called Martin chuzzlewit when he describes all these sickly people in Illinois in Illinois and the confluence of the Mississippi and the higher river. He's clearly describing malaria. Wow, I did not know. So what stopped it? So that's a great question. We so there's actually a very nice book written by a medical historian at Duke University. And they Margaret Humphreys called malaria race in poverty, and she has offices. But I think she's onto something that it the decreased the malaria. Dropped in associated with aggressive economic development. So that the FDR's new deal included something called the agriculture adjustment. Act that got people off of off of with agrarian pursuits and put them into factories quality housing went up, and that's probably what caused a lot of the reduction in these tropical diseases. Remember there really diseases poverty. I spent a lot of time working in China. And I'm seeing that play out right now in China. China has cuts his very very aggressive program of economic development, mostly in the eastern part of the country. But in the southwest part of the country, go into you nonstop Sean provinces, you go back in time seventy five years, and you still see those diseases so spread de think that the best cure or the best way to stop malaria would be just to increase the economy of these areas in Africa, where they're experiencing at clearly economic development is a very potent driver. Now what it is about economic development. We still don't have. Our arms around that yet. But economic development is very important just like for the neglected tropical diseases. We study, but you know, unfortunately, for many countries economic development is still decades away. So that's why that's the rationale for developing. These vaccine is it because economic development moves people into more urban environments where there's less tropical diseases. I think that's part of it. Although now, we're seeing some tropical diseases thrive in urbanised environments like, you know, yellow fever and and dingy as well. So it's not only urban is Asian. You has to be urbanization with good planning. That's not done unchecked that outstrips the infrastructure in terms of water and sanitation. So this brings me to the thing that I wanted to talk to you about in the first place because this is what you brought up to me when we were doing this fi show. And you you said something to me that it's been haunting me ever since that the vast majority of people that live in tropical climates have parasites. Vast NPR. Yep. That's right. That's right. There's things like talk so plasma Condie. So let's look at the let's look at the hit parade. Right. The top one is one called ask risis intestinal roundworm on the estimates are on eight hundred million people have asked us roundworms in their bellies. Well, so we hundred good sailing. Some more than one in ten people on the planet and mostly people who live in extreme poverty. Four hundred million have hookworm infection for hundred million have whip more. So these are warming diseases two hundred million people with scabies, which is an echo parasite on on the skin causes. Terrible itching and secondary bacterial infections schistosomiasis, another one the point is every almost every single person. Who's in extreme poverty has one of these what I call them neglected tropical diseases. And what are the interesting features about them is they're very debilitating. They not so that not only occur. In the setting poverty. But I think they reinforce poverty because they make people too sick to go to work, they make they actually shave we can show the shave IQ points off of kids when they have them. Well, this is the hookworm connection to the idea of the slack jawed dumb southerner. Right right states of America. Right. And now one of the things that we found so RA RA Helio Mahia on my faculty working with environmental activists named Catherine Coleman flowers and Alabama found that hook where missile present Alabama among might not to people. So they they understand what we're talking about. Because for the longest time. There was this stereotype about people that lived in the south that they were adul- minded, right? And this could be directly connected to hookworm infection which had run rampant. Right. There was even the term given called they called the germ of laziness than hookworm infection because it causes severe Nimia. So if you're walking around with terrible anemia, of course, your your to your. Not feeling up to working a full day and all that sort of stuff hookworm was widely president president in the southeastern United States turn of the twentieth century. And then as malaria went down with economic development. So so did hookworm infection as well. But we still have pockets in this country in this wasn't understood at the time. They didn't know that these people were infected with corm. For for for forever. No up until very recently. So the cause of Okram wasn't discovered till nineteen hundred what is that? 'cause it's called indicator. Americanise the American killer is and that's the name of the worm and this walking barefoot or that goes in through the hands or in enters all parts of the body. So it's very common to get it from walking barefoot. That's right, which was more common in the south. Right. Right. And so that's one of the diseases we've made a vaccine for this now in clinical trial. Yeah. When I found that one out I was like, oh my God. Well, that's it that totally makes sense. Because for the longest time was there was that stereotype. And then we find out that it's directly connected to a massive infection of this diseases worm. So these are the diseases that are holding back people who live in poverty, you originally thought only places like the poorest countries in sub Saharan Africa or southeast Asia. But now, I realize it's these pockets of poverty across the entire planet that people are affected by these disease in these. Diseases can be vaccinated. That's where we're trying to prove that we can make a vaccine again. And there's a hookworm vaccine right now in clinical trials Justin clinical wasn't there a Lyme disease vaccine, but the problem was it was actually causing people to get lime disease. So that's a to talk about controversial topics that so there was a Lyme disease vaccine that was developed actually from a colleague of mine ill university. Then it was and they licensed, I think it was to GlaxoSmithKline and they developed it as they call it lime Rix, it was the Lyme disease vaccine and actually most of the study suggests that actually worked pretty well. The problem was there were a number of people who felt that the vaccine made them worse or the said, they had chronic Lyme disease wasn't effective. So it was really a market perception problem more than anything else in the Welte. Mentally, it hurt the bottom line of the company, and they they withdrew it for my friend of mine's, dad got the vaccine and then got Lyme disease. They. Think he got Lyme disease from the vaccine probably not. Probably a weird word lime. Does that's being nice. No, he didn't get lime does no way impossible possible because Lyme disease is caused by the lime bacteria the Spira Kate called beryllium Bergdorf ri- and the vaccine is not alive vaccine, it's a recumbent protein based vaccine so it's not. So there's nothing in that vaccine that could have caused this adverse reaction that they directly attribute to that vaccine. Probably not. Again, you're saying, well, I don't know the patient. I don't I haven't Sam salmon the industry, I hate to swear. I mean, that's the narrative that household. Well, again, you know, what's reinforced by a lot of negative information out there on the internet also reinforced by the fact, they pulled the vaccine pulled the vaccine not because it wasn't working, but because of market perception, and and all that sort of and that was a time before the number of cases of disease have really taken off. So it seems strange to me because they didn't pull the measles mumps rubella vaccine because of perception, why would they pull the Lyme disease vaccine because of perception, I think the reason was is because the the cost benefit equation works a little differently with measles. Measles is a killer disease. Lyme disease was not a killer disease, and directing people now in some case, it seems to be connected to a host of other ailments too. Correct. Like, Lyme disease just. Exacerbates a bunch of different maybe possibly even existing health issues. Well, you have to be careful, you know, the the and this gets into another controversial rabbit hole. I'm not sure we want to get into or not today, but, you know, the infectious disease society of America, for instance, has come out with a strong statement saying that there's really no such thing as chronic Lyme disease. And I'm the scientific evidence does not support something called chronic Lyme disease. He got there. Lots of people suffering with chronic debilitating illness who claimed that it's caused by lime disease. Yes. So this is something that is out there right now. Why is there a debate? Like, what is what it? Why are they saying that there is no such thing as chronic Lyme disease? What's their evidence, the evidence is that there's no evidence that they can detect Spira Keats in the body in many cases, people who've had Lyme disease. Don't have persistent evidence of having an. Nobody's any longer to through the lime spiky. So it's a whole different area. Right. But they do have this, chronic inflammation and pain in their join to have somebody starts breaking down. They have something. But it doesn't seem to the affections society of America, which is one of the lead infectious disease bodies in our country, and I'm not an expert on Lyme disease. So I'm not too comfortable going there with you are saying that there's no evidence that that that's actually associated with active infection with Lyme disease. What are they? How are they describing it? And what how are they saw another? What's so what's causing all these on, the unknown? But isn't it bizarre that they Saint people got Lyme disease first. And then how these host of issues afterwards. The I guess part of the problem is in some cases, they had Lyme disease. I in some cases, they really didn't have lime disease. Unfortunately, there are number of unscrupulous healthcare providers, and even physicians how there that are made. Taking misdiagnosis either they're making a misdiagnosis of Lyme disease, or in some cases, they're actually taking everyone who comes through the door and diagnosing them with lime disease. I'm sure you're where the Lone Star tick writing the allergy to red meat. Yeah. Right. That's really fascinating. Yeah. And that's another one that's on the rise. Correct. Yeah. Well, actually, all tick borne diseases are on the rise now possibly because of climate change. Which is another factor this doing that. So we're seeing you know, if you look now at what are the big drivers of infectious diseases right now in the in not only in the US book globally there really some interesting forces and a lot of them are social determinant. So a big one is poverty. That's that's a huge one. The other big one is political instability in war because it interrupts public health control measures. So for instance, then as Walea which was leading public health control and Latin America for decades. You know with the collapse of the economy and the and the shabas era now into the Madore area Madora area. We've got a terrible situation where we've had measles return to big way. So huge numbers of cases of measles while we had all the neglected tropical diseases come back as well as malaria showbiz disease leash Manassas. So it's really interesting how that is destabilizing the whole region because now Venezuela has one of the largest diasporas of people as big as the diaspora coming out of Syria, Iraq. So now, the diseases are moving into adjacent areas of Brazil and Colombia Ecuador. And so it's really an and that's another big drivers, political instability, the third one, we think is climate change may be very important. So, you know, why did we see this big surge of chicken Guna virus infection in the western hemisphere or Zico, we don't really understand the forces of that. And what's going on in southern Europe? Right now is quite. Turning we've had malaria return to Greece after it's been gone for seventy years malaria's returned to Italy. We're seeing schistosomiasis neglected tropical disease on the island. Of course, we've got Dangi chicken ganja West Nile virus across Italy Spain Portugal. So we're trying to understand why that is. And there's some thought that climate change may be big driver that now what other infectious diseases or parasites rather? Do they have vaccines for today have a vaccine for taco would there's no vaccine for tax plasmas? There's a a prototype malaria vaccine. That's yeah. Well, it's it's an there. There's a malaria vaccine it's called Mosca Rix, the trade name that was developed supported bun with a lot of funding from the Bill and Melinda Gates Foundation and working in partnership with GlaxoSmithKline and that malaria vaccine. Scene now has been approved for use in children by the European medicine agency. And it's being introduced now in three countries in Africa allowing Ghana and I forgot the third one. I think is there an adverse reaction that people have that stuff because I know the traditional malaria medication. I had friends at took it and had horrible nightmares. Malaria is terrible. Yeah. Gives you very lurid dreams. Yeah. No the so far. No. And so there when you say children, how old are the children that they're vaccinating with this. Well, the problem that you get into with malaria is that before six months of age you have maternal antibodies and remember the original born with antibodies from your mother, and they'll start to wane by six months of age. So the ones who get hospitalized with visas. What's called cerebral malaria, which is a devastating condition or severe malaria Nimia? Which is also a killer are those children between six months of age. And five years of age. Those are the ones that we want to protect now, and it's one of the leading killers of children globally. Right. Right. And and we don't end the vaccine sickle. Some is connected to crack, right? Sickle cell is. It has something to do with people developing an immunity to malaria. That's I'm surprised he knew that from Tiffany haddish who's diffent habit. How dare you? She's a very funny comedian. Okay. I'm sure she is. But she's well, she's really, wow. That's it's not really immunity, but it's a natural protection. So individuals who have the sickle cell trait. Seemed to be partially resistant to malaria, and that's the thinking why the gene for sickle cell has been preserved in Africa for so long as because it does confer some protection against malaria. So it's a reason for keeping the gene in the, gene pool. Yeah, we were actually discussing because a friend that I grew up with died from it. So it seems to only exist in African Americans or Africans is that correct pronounce now, there's some other places as well. But predominantly plays an African and mung African Americans or people whose ancestors came from the tropical climates where. Yeah. So it's it's really quite an amazing story. So there's no no no vaccine for taco plasma. Is there? Anything on the horizon is anything we worked on because that's a big one. Right. It's a real big problem on people with HIV aids. For instance, that's a because it reactivates your talk so plasma asus. And we even seating. I've seen in kids sometimes, but the thing. Well, what happens is it's in some countries up to thirty percent of people are actually infected with toxic plasma. And the parasite has the ability to undergo a dormancy state in the body until your immune system gets compromised either because of aids or because if you get some kind of medicine that suppresses your immune system, and then it can reactivate and cause let's call it cerebral, toxic plasmas, quite serious. So most people handle their toxic plasmas, very well. You know, you you you die with it. And don't even know you have it. But in some cases, it gets reactivated right now. There doesn't seem to be a lot of incentive for developing toxic plasma most vaccine, although I'd be very interested to to work on something. Like, why would they be no incentive at such a large scale disease? It's hundreds of millions of people worldwide. Right. That's right. And part of the problems. We have almost no information on the actual number of people who. Have it? And how extensive it is. So we call that disease burden. We don't have good disease burden. Estimates of toxic plasmas trying to get tested. I've had a bunch of cats feral cats. Yeah. You preach them crazy. It was a good chance. You're you're are infected, but I'm sure immune systems intact than you're okay. Now, there is a a related disease that from cats called toxic crisis. And that's a parasitic worm infection. We're finding in the United States among the poor. And that's a weren't. So what happens is if you go into poor neighborhoods. You know, and you see a lot of feral cats dogs and poor neighborhoods. Almost one hundred percent of them have this warm in their intestines and their seating the environment with eggs in their feces and the feces are spread all over the poor neighborhoods. Kids come into contact with them in the worm has the ability to migrate through the brain costs, the rebe real toxic crisis. And I think it's an important cause of developmental delays. It's one of those neglected diseases among in the US about in the book and. No vaccine for that. He was no vaccine for and we knew very little awareness about it. Wow. Yeah. I've never even heard of it until just now. Right. So it's not rare. I mean, in some cases, you know, up to ten percent of certain populations like effort African Americans living in poverty are infected with it. And it's primarily pets or does. Is it rodents as well? Mostly stray dogs, and it's not even pets. It's mostly stray dogs and cats, and and I and this is an example of neglected tropical disease. Here's here's a disease of up to ten percent of African Americans living in poverty in the United States. And almost nobody is studying while right, and it can affect the way your mind functions. Right. It's an and it's been linked now to developmental delays. So, you know, everybody wants to know why, you know, kids living in poverty have developmental delays. And people just assume it's because they live in deprived environments, and that sort of thing, but I think toxic crisis is an important underlying reason for it. And this is an example of the. Elected disease. We I mean, everybody's heard of Ebola. Right. And everyone's worried about he belon- and the truth is he bowl is never gonna come to the United States was never going to be because it's too difficult to transmit unless you have a complete collapse in the health system. We're never going to have your Bulla epidemics in the United States. But here's a disease of ten percent of African Americans living in poverty, and no one's heard of it. And there's no incentive to study it. So that's why I'm trying to raise awareness about these poverty related diseases. And that's why I don't understand. Why people don't talk about that one? That one seems insane right. Yeah. Absolutely. It's a no brainer. Right. And so, but you know, it's very hard to get people to care about disease poverty. I mean, and this is one of the striking things about when I wrote the book was I've had a lot of success getting people to care about neglected tropical diseases in Africa and worked with the US agency for international development to support a package of medicines. That's now begin ministered to over a billion people annually. And that you know is one of my proudest accomplishments is is helping to raise awareness about neglected tropical disease. Like, we've been talking about a good Gorman schistosomiasis in Africa Asia Latin America, but the minute I talk about poverty related diseases in the US the lights go. Why is I don't know? I can't I can't figure out what I'm doing wrong. If it's so much success getting people to care about NTD's neglected tropical diseases in in poor developing countries. But you know, there's been no response to this book. I mean, it is and the estimates that I come up when the Booker we have twelve million Americans live in poverty with an elected tropical disease toxic crisis is one of them another one shoguns disease, and the list goes on it's been very hard to get people to cure about the poor in this country. That's very strange to me. And I've always said that about the way we treat other countries we want to send them aid and rebuild these countries. But we don't do anything about these terrible. Communities that have been terrible in this country for decades on decade, right? And so I try to make the point the world has changed. You know, this this old norm of global health developed versus developing it's still exists. But it's going away. We're what we're seeing is a general rise in all all the communists. I mean, some African countries of eight or nine percent economic growth, but it's all leaving behind a bottom segment of society. And so I don't care where you show me poverty, whether it's an Texas or Alabama or Nigeria or Bangladesh, I will show you these poverty related diseases. And you know, I I know what's your name AFC. The congressman from New York has talked a little bit about hookworm in Alabama. So last time I was in Washington dropped off a copy of the book interoffice. But no response yet. She's probably pretty busy too. Yeah. She's doing a lot of other stuff. You had a magic wand. And someone said you could do whatever you want to fix this. What would you do? So I did meet with a couple of people on the hill. And they asked me that question. What's the magic wand? And there's a couple of things one we need to actually look for these diseases because the problem is they're the the disease that caused a very subtle developmental delays. So that if you're you know, a kid who lives in poverty with developmental delays. The pediatrician doesn't even think to do a test for toxic crisis. So that so we need to raise awareness. We need to go into poor communities across the country and actually take a blood test and actually measure for the presence of that disease or that parasite once you find that disease. What would you do that? Well, it depends on the disease in some cases, we have treatments for the treatment for toxic crisis. As a five day course of simple pill of all been dissolved cures it and it cures it. So yeah. So we have you know, we have interventions so one, you know, doing what I call active surveillance looking for these. Seizes the other one is really trying to understand how these diseases are transmitted. What is it about poor neighborhoods? That is facilitating transmission, I think the third problems the diagnostic test themselves because they're very complicated tests. Sometimes, you know, the done at the centers for disease control and prevention our lab at our national school Tropical Medicine does a few of them. But it's not like, you know, when you go for go for blood work in your doctor, and you get a little lab slip from Quest Diagnostics with the, you know, the blood chemistries, the blood counts. There's no box there for toxic crisis and shaggy this. So we need more improve tests point of care diagnostic tests, not just proved test, but just let make them more accessible. Yeah. So they don't have to send it off to the CDC or to our national school of Tropical Medicine is their treatment for taco. There is a treatment for toxic plasmas. With is. It's a para method means self a'drug. But it requires a long treatment course, how long I'd have to look up the number of days. I haven't treated a patient with Doxa plasmas in a while. But and it kills it effectively. He can really, oh, I thought it was something you kept for life. Well, if you don't get treated, right? Okay. So then if you're immune compromise in the comes back, then that that's a problem this. Well. So most people that have it really don't even know they have this, right? Yeah. And actually in most people who have neglected tropical diseases. Don't know they have it. So that the and Texas for instance, we have transmission of a parasitic disease called shock as disease, it's a cause of heart disease. We are members of our faculty were actually able to track down individuals who had donated blood and the Gulf Coast regional blood authority actually found somebody show people positive for Shabbat disease. They were told to go see your primary healthcare provider, and the unfortunately, the primary healthcare providers not educated about these diseases, and they just assume must be a false positive. So, you know, our faculty attract them down able to get them into treatment. And what is it treatment for it? It's a it's a an anti parasitic agent called bids nasal in that kills it. That can kill if you catch it early enough. But sometimes you don't catch early. So it becomes a stemming then. You have then that's why we're trying to develop a therapeutic vaccine for this disease. Oh, but again, it's a therapeutic vaccine for poverty related disease. So it's it's very tough cow, man. So the point is these diseases are widespread among the poor, and we just don't pay attention to them. Yeah. That's it's. And so I think you know, again love to hear your thoughts. I mean, what is it that we just turn our backs on the port in this country. And it's it's disturbing. It's very disturbed a dismissive app and and disproportionately affect people of color as well. Right. Yeah. Because you know, because it's so linked to poverty. Well, also, right slavery. Yeah. I mean, I mean the history of slavery in this country in the history of systemic racism and places where they just literally would not sell homes to people who are African American all these things are connected to the the contribution of maintaining these impoverished communities, and there's been almost no effort whatsoever. Other than the people living in the community trying to do better. Her and raise everybody up, right? There's been no effort whatsoever by the federal government to step in and try to rehabilitate like a large scale approach to rehabilitating places like the ghettos of Houston or Baltimore or control. You know? I thought I knew at poverty living. I was before I moved to Texas in two thousand eleven I was chair microbiology George Washington University. And I thought I thought I knew it poverty looked like I moved down to the Gulf Coast. It's different animal. I mean, the the depth and breadth the poverty in the Gulf Coast, and the southern part of the United States is just extrordinary, and it's been very hard to get people to want to really take it on and really address these these poverty related disease. Do you think what do you think the cause of it is maybe you've you've studied this for quite a while what the cause of the neglect? Yes. Yeah. I don't know. I don't know. You know is something about American exceptionalism or something. We just don't want to admit we have poor people. I don't know. You know, I wasn't the first to come up, you know, to raise this issue about poverty when I was in high school or junior high school, I was forced to read a book and at the time I didn't care about. It was called the other America was written by fantastic, social activists, Michael Harrington. Who was I think someone toys, very devout Catholic, actually? So he wrote this book called the other America talks about the hidden poverty off the road and actual number of people who live in extreme poverty hasn't changed since that book was written in the early sixties that book was hoped was what helped Lynn didn't I Kennedy than Lyndon Johnson launched the war on poverty in nineteen sixty four. I dusted off that book, and it's still it's still works today. And that's all right started talking about my book, blue marble health about that book the other America, Michael Harrington. Yeah. The that is a very strange thing are except. Since of these communities, and I mean, I've always said that if you wanna make America a better place the best thing to do. Is not invade other countries or intervene. The best thing to do is try to rebuild these impoverished communities. Yeah. Well, Gandhi Gandhi people way out Gandhi, one set of civilization as judged by the treatment of its minorities. And yes, we're not in by that criteria. We're not doing. So well, you know, the we our country was visited by the United Nations special repertoire poverty into twenty seventeen and his numbers came up with we have nineteen point four million Americans who live in what's called extreme poverty that is it half the US poverty line and roughly around five million Americans living less than two dollars a day the same benchmark used for global poverty everywhere million. Yeah. And and guess what those probably all have neglected tropical diseases five just just like just like those living in extreme poverty in Africa, Nevada million people living on fourteen dollars a week to two dollars a day. That's insane. The university of Michigan center on poverty is also shown that we have forget the number two point seven million families living in less than two dollars, which is probably about the same as the five million number Jesus Christ. Yeah. And again, this is not a topic. That is very popular. I mean, when when you see presidential debates, this this is not something that comes out, nobody talks about it. And again, even for disease. I mean, what are the diseases? We hear about Ebola and diseases like that and sometimes on my frustration. I say, you know, we're deserve imaginary diseases, and yet here we've got widespread diseases of the poor in the US and the lights go you remember when that woman came back from Africa, and she was a nurse and she had been some in some connection contacted with the Bola. She didn't have it. And they wanted to quarantine or. Oh, yeah. And they they stuck around and some cabin on the airport or. Something crazy terrible. But did you think about that? I just thought it was so cruel, and is it just a an ignorance of how this right? How is it transmitted? Well, actually bowl, you know. It turns out the opposite of measles measles. One of them was contagious. Diseases known. It has reproductive number of twelve to eighteen with that means if a single individual gets measles twelve to eighteen others get it because the virus hangs around in the environment. And it's so easily transmissible hangs around the if you touch this table. That's right. That's right or even in the even the atmosphere. So, and that's why you get these really large measles. Outbreaks like, you're seeing in Washington state. And usually those are infants under the age of twelve months old enough to vaccinate the ones that went into possible is sick the. Abolish, just the opposite, Ebola's reproductive number of two or three. So unless you're taking care of dead or dying Ebola patient or someone has recently died because it's only towards the end stage of the disease that you really get large numbers of virus particles in the body. You're not gonna get any Bola. So the reasons being so hard right now to contain a Democratic Republic of Congo is not because it's so highly contagious. It's just that the place is is decimated by the collapse and infrastructure associated with civil war. So even though we have a now any bowl of vaccine, it's hard to vaccinate everybody. And how is it? Transmitted Ebola by contact with fluids of somebody with with people. So it has to get into your tissues, right? What else should we worry about? Freaked me out. Well, the point is a lot of these diseases are solvable. If we just put our mind to its or even aware of it and was one of the things I say in the book is if because these diseases, oh, so widespread among the poor and the twenty countries if we could get the elected or the leaders of those g twenty countries together to twenty summit and say, we're really going to do something about the neglected diseases in our own borders and include the United States, we could get rid of two thirds of the world's poverty related diseases right off the bat while so a lot of it is political will ignorance or lack of awareness and political will. Well, it seems like in this country. Ignorance is a big part of it. Because this is something I've thought about may times, but I didn't know about Chagas to know about a lot of these other describing. Yeah. No, I mean, so we we need to raise awareness about these. That's why I'm so thrilled. So thrilled to come here because I've just amplified the number of people who've heard of this concept of blue marble health is the name that have given a different name from global health to two separate separate it from the two. So, you know, coming on here is so powerful in terms of amplifying that message. So again back to the magic wand what what could be done. I mean is it a funding issue or is it at first before that education issue? Well, I think the there's multiple issues. So I mean, if again, the the drivers we've been talking today about promoting these diseases really tough to do anything about extreme poverty, Warren conflict climate change climate change. Clear that there's things we can do aggressive on checker organizations, but the other things that you can do is build better tools by vitamin better diagnostics, better drugs, better vaccines and unfortunately for these poverty related diseases. There's no Mark incentive for it. So it falls to academics to professors people trying to do this in the nonprofit sector, and we're doing the best we can. But it's not nearly as good as having access to getting the the pharmaceutical companies involved as well, it also seems like it would this would cost an insane amount of money to go through all these poor communities test everyone start distributing these these drugs, and what would pay for all that stuff. Well, you know, some people have asked me a little what would the Affordable Care Act take care of this? And I said, well, we're two steps away from the affordable twos. Two two standard deviate. Not just end. DVD two degrees of separation away from the afforded. Characters. We're not even having recognizing these diseases. Yeah. You got know about it. I I mean, most I what percentage of the population even knows about right? All these parasite created diseases or know that vaccines don't cause autism. Yeah. Well that one is that that's the biggest one. Yeah. I mean, that's a tough one. And again, I don't understand it. I mean, I'm just saying I'm saying vaccines don't cause autism because you're saying, right. You know, and I think this is part of the boat is a lot of part of the problem that we're in this boat bunch of people who are scientifically illiterate like myself. We're discussing these issues who don't really know what they're talking like, I I saw someone talked about tetanus because some boy had tetanus and he was in the hospital for a long time and his his bills hospital bills like a million dollars going. Yeah. Yeah. Because it's an ICU admission. Right. Right. And they were saying, hey, you know, why didn't this kid get a ten shot and? And it it goes back the same thing. Right. That people don't want these vaccines may prevented. And again, I don't blame the parents. I think the parents in some ways are victims themselves are victim of this very aggressive misinformation campaign that's out there. This is a big one though, isn't it? Yeah. Tetanus, and we have a vaccine for that's part of the what's called the DP t that's one of the first vaccines. You get as an infant. There's no excuse for having a tennis case in the United States. Right. And this kid was unvaccinated, right? Yeah. That's my understand. Yeah. I mean is there a cure for tetanus outside of vaccines? Well, I mean, there are supportive measures that you can do. But you know, they require hospitalizations ventilation put in a respirator. It's it's an you could still die. So it's it's awful awful disease. I've seen tetanus working in Central America. And else where you see a case of tetanus. You never forget it with what is tennis tech. Well, the other name is locked Joe where your muscles go into spasm. And and you see. And including the muscles involved in breathing. So you can't even breathe as a result of apparent that freezes the muscles. What what is doing it? What's doing is? It's actually caused by bacteria, the bacteria, Lisa's a toxin called tennis toxin. Sounds like a horrible way to go its terra these are awful diseases. And I think one of the things that the anti vaccine group or lobby is I call it does is they try to be very dismissive of these diseases. They try to deliberately downplay the effects, I mean, you'll see the stuff on the web measles. Build your immune system. You said it yourself. So you didn't read it. Yeah. I just saw. Yeah. So that doesn't make any sense. It's crap. Right. And what are they saying? What is what is the best thing is just a rash and build your immune system? It makes you stronger, it's it's it's something out of from a different planet. I don't know where we do. I think the reason for that becoming popular is because you we do kind of helicopter parent our kids a little bit too much. They should come in contact with a bunch of different things because it does build their immune system. Correct. Well, that's an interesting hypothesis called the hygiene hypothesis right says. You know, if you kids are living in too sterile environment than this can also result in auto, immune disease and things like that. But in ours allergies, and I have mixed feelings about the hypothesis to me, it's not not airtight by any means, you're type, but it's there's there's some sort of a correlation particularly between peanut allergies and keeping peanuts away from children. And that there was a study show those John hates work in one of his books. Talked about how there was a study done in communities where they didn't protect kids from peanut allergies and this much smaller percentage of people developing peanut allergies versus kids that they did. Yeah. This is also one of the things that the vaccine lobbies doing now that are you know, when I write a book like this vaccines, don't cause autism. Now. What you're seeing? Remember, I told you about that wacko all business where they went from 'em MR to Amarah Saul to spacing vaccines too close together to Lumine them. Now, there's some groups that are moving away from autism altogether. And now they're saying well vaccines cause auto immune disease vaccines cause other neurologic deficits. But it's all it's all flimflam. It's often from what is there are there are vaccine courts though, right and vaccine vaccine courts, and they have handed out payments to people who were injured by vaccines. Right. What what does that? So, you know, it was for instance, if you look over a ten year period, I think it is between I haven't looked at the numbers in a while. I think it's between two thousand eight and two thousand fourteen two thousand fifteen over that period of time. There were two point five billion. Doses of vaccine, given two point five billion of which the vaccine courts identified around two hundred that were a list of serious injuries that could be that they have a table of that they could attribute to vaccine. So there were two thousand payouts another two thousand eighty percent. They didn't really think we're tributed to vaccines, but they paid it out anyway because that's how the courts work and then two hundred where they could really say yet looks like this could be related to vaccine. So you divide two hundred two point five billion that's one in ten million or even two thousand by two point five billion. That's one in a million. And these cases what was happening to these people other than the shoulder injury that you were talking about. Yeah. There's a there's a list, and I talk about it in the book. There's actually a table. You can download it on the web of for each vaccine a list of potential injuries. They allow and these potential injuries is it as we were talking about earlier is this just biological variability that some people react differently to different things. I think in some cases, we don't know another cases, you know, with the live virus vaccines, if you have a severe genetic immune deficiency. Maybe it wasn't picked up. Then that then there's that risk. But you know, what's what's the one in a million? What's a one in ten million risk as I said, we have to keep that in perspective because the odds of getting hit by lightning as one in seven hundred thousand and if you believe that number or, you know, what's the risk every time you take your child out on a car and drive around the neighborhood. I'm sure the risk is far higher than one in a million and the real danger. There is actual infectious diseases. Spreading the damage. They could do damage thing. Like they're coming back. Yeah. Yeah. Yeah. Meet measles is is an awful disease causes measles. And Steph Elijah's measles pneumonia. I find that a lot of people that are that are steadfast in their resistance to vaccines. They also believe in a lot of other questionable things, it seems like these things get lumped into these groups of things that they don't trust the government about right, right? Yeah. I think that's I think that's probably true. Yeah. That's which which was she government. Which was which was well, you know, it was interesting. So you know, I said we know we need to hear from the centers for disease control more in the surgeon general now starting to speak out. But you know, the people counter that well part of the problem is people don't trust their government. And I said, well, that's true of some. But I think most people if you know, if we had a, you know, more visible public health force out there, people would listen to it while I think that what you're talking about in terms of these poor neighborhoods in these parasites getting into people system in effecting cognitive development. And what was the other one? Besides Chagas was toxic crisis crisis cognitive development. The fact that there's actual cures for these things to the mean that I estimated at a paper there two point eight million African Americans living in poverty with toxic rise. Wow. This is not a rare disease. Joe this is this is a common disease. But it's so no, but it's occurring among the poor and chronic and debilitating affection. It's not. Attic, it's not ninety bullets. Not healing people is this mostly. And this is what climates as well. It's probably it's more common in the south than in the north is it because they've long longer time to this because the extra the extra and the environment in the worm develops with within the is there any other diseases that are going on that we don't know about. Yeah. Yeah. Sure. There's other there's a brain parasitic infection. Called sister coasts that one is from eggs often from individuals who have tapeworm. Oh, so that's where we're seeing cases of that. There's some of the viruses transmitted by mosquitoes. One of the ones we don't talk about a lot which is very serious infection as West Nile virus infection. That's got very high rates of not only in suffo- litis. But also one of our faculty members Christie Murray showing very high rates of depression and other neurologic. Debilitation for and that's another one we could probably use a vaccine for. But there isn't the Mark incentive to do it West Nile virus does come up though. At least that's discussed in the news and people aware of it. Right. But there's no vaccine there's no vaccine, but there could be what does it there could be holding? It back that's holding. It back is lack of market forces lack of financial incentive for the pharmacy local companies to take it on. So there's an extremely large investment to develop something along those lines. That's right. I mean vaccines are through an investor's perspective a tough sell because you know, there's a possibility. The first of all you need many years of clinical trials, it can sometimes take two decades from the original conception of vaccine to actually going through clinical trials, the hookworm vaccine I've been working on we've been doing it since the nineteen ninety s so we're talking decades long time horizons when you talk to an investor about something with decades long time horizons figure it out, right? The light the lights go out. I mean, the very quickly. So we're gets gross, right? Because this is all we were relying on these private businesses. Right. Invest money to cure a public health issue. That's right. That's right. That seems kinda crazy. Well, so in response to that what happened was after the Ebola fast in two thousand fourteen where we didn't have any bowl of axion in Guinea Liberia. Sierra Leone group of individuals came together. Dav owes the World Economic Forum, and including the Gates Foundation, and they put around they developed this concept, or which an organization called Sepe the coalition for preparedness innovation to incentivize biotechs and pharmaceutical companies to embark on diseases for which of pandemic potential like Ebola like Lassa fever like mayors corona virus infection, and that was great. But the problem is they didn't address these poverty related diseases. So those of us who are working on poverty related diseases are still kind of on the outside looking in just seems like. Having everything managed by private companies that need to they need to have some sort of financial incentive to attack these diseases that seems like a crazy way to deal with health crisis. That's right. That's right. And so what I've recommended as I said the that organization. Sepe is great for what it's doing. But we need another mechanism. What I've proposed is that since these diseases are so common among the poor and the g twenty countries these are the twenty largest economies to put together public sector funds for that purpose public sector funds for investing in developing vaccines and treatments for poverty related diseases. These chronic debilitating diseases, and in fact, you know, we can show that the using working with health the communists, we actually work with a terrific health. Collumnist name is Bruce Lee of all of all he's a professor Johns Hopkins. Yeah. Right. He loves it. And he's he's been able to show that are vaccines are not only cost effective there cost savings meaning that their economically dominant that they'll actually save money. The problems you still doesn't help you with the fact that you still need some. But the return is on public health. You still need somebody to come along and provide them investment. Yes. So, you know, so what's happened is our our technical ability to develop vaccines has out stripped. Our our our financial instruments that we have to do it. So I get a stream of young people in my office wanting to go into global health. I mean, the commitment for this next generation, and no they get a lot of bad press. But my impression is this next generation their commitment, the public services at an all time high, and they say, you know, doctor who has them all in I'm going to go into global health and they're a little bit disappointed. When I tell them get an MBA or get a law degree because where we need the innovation now is in the in in the final. Sector. There's a there must be a business model out there that would work that would figure out how to do this. I just don't have the background to do it. It seems like once the momentum is in the corner of this being handled by the private sector, and that the private sector has to develop these vaccines and these treatments, and they have to do it with some sort of financial incentive. If they don't have a bucket of gold at the end of the rainbow to not going to take a ride. That's right. That's right. So that's crazy. It's crazy. But that's reality. And so what the exciting thing about what I do is developing these vaccines for poverty related diseases. There's no roadmap right now that we're in clinical trials. I don't know what the roadmap is to get to licensure. And getting these vaccines out to the public. The terrifying thing thing keeps me up night is there's no roadmap. Both. Good good. There's a how much does it cost to get a vaccine? I mean in general from develop. Mental period to actual application. Well, the pharmaceutical companies have traditionally said billions, but I don't think that's the case. I think one of the reasons. Be the they're doing that is because they're also recovering. There are in D costs. You know, they're putting money into our area that they that they that they charge in order to, you know, either make a profit, or at least a even so for instance, the cervical cancer vaccine, the HP vaccine that you know, when I last look was four hundred twenty dollars for the three doses. It doesn't take cost four hundred twenty dollars to make that vaccine it it's just that they're recovering there are in D costs, which is which is fair enough. So one of the things that we're proposing to do for our neglected disease vaccines is will de link the RND cost in other words, if we've gotten grants whether it's from the Gates Foundation in the past or or the NIH or European Union or the Dutch government or the Carlos slim foundation, we're not gonna pass those costs on. We'll just you know, that was used for our in D, And we would just caused for the cost of good. So at least we can get. It down to just a couple of dollars a dose a few dollars. Those now for anybody listening to this conversation, and they have additional questions. Where's the best place? You should guide them. Would it be your books? Probably the books because I wrote the books for lay audience as my lay audience is sort of. I mean, somebody with a car university education. But I mean, they're not, you know, it's there they're published by Johns Hopkins University press, so it, and they are kind of their uneven in terms of how weighty they get into the science. But certainly the vaccines not 'cause Rachel's autism. I wrote it with the idea of parents axiom hesitant parents. And also, the pediatricians because the other problem with pediatrician says, you know, they're they're in their office, and parents are greeting the stuff on the internet, and they come in loaded loaded for bear into the pediatrician's office with all these factories, and the pediatricians like, gee, I never heard that before. And and then the pediatrician has made to feel stupid like he's not keeping up with the science. He is. She is. But it's just not keeping up with the misinformation so provide talking points in the epilogue of the book and blue marble health is the best resource for people to understand about diseases of the poor and wealthy countries. Then I have a third book that I wrote a few years ago called forgotten people forgotten diseases that describes the neglected tropical diseases. Well, I really hope that what comes out of this is someone gets motivated to create some sort of a documentary really on both subjects. I mean, I think that we would greatly benefit from some clarity for people that do have concerned about autism. That's in digestible form for good or for bad people like to watch documentaries. Right. I, and I hope you don't get to beat up over this because I know the anti vaccine groups are very passionate, and well, I mean, they have a position they beat me up. Well, they've that's well, they beat me up a lot. I go after you. And they're to call me a shell a show for a lot of things they'll be. On leaving the rounder. Jamie has a t shirt that he sells at young, Jamie dot com. It's round earth. Schill right. Literally, I've been called around earth shell and earth is flat. And there's a lot of those. I don't know if you know, I didn't know that there's a lot. So you get beat up. No matter what if you talking. But so, but I really think it would be it would do a good service. If somebody did put together a documentary because I don't think most people are I think most people are just relying on this fear like that vaccines cause autism. There's also this connection between people that are older. Correct. When when they're older, and they have children, there seems to be more likely there seems to be in that may be related to as you get older your sperm or your egg have some genetic instability and more likely to produce mutations. That's probably the MAC that would go hand in genetic basis of autism. And then the blue marble health book. I mean, you've been saying today about these diseases, and how many of them exist? How many of them are almost unknown untreated undiagnosed and just how many people are unaware. I really hope that someone does something about that too. But in the meantime, people can buy your books are they failed audio as well? Definitely the vaccines. Do not cause Rachel's autism is audio books, and I'm not sure about blue marble health. Okay. But you can get it or not Amazon thanks for being here. Appreciate it's good. See again. Thank you for raising awareness of all this stuff. I really my pleasure. And I appreciate you coming down here in explaining a lot of this stuff for us. It's been a great time. I really enjoyed the opportunity if people want to get a hold you on Twitter. What is your Twitter just Peter hotels? Okay. Thanks her pre cue. Thank you, everyone for tune into the show and thank you to our sponsors. Thank you to perfect Kito, delicious, yummy bars. They're nut butter is fantastic. They have excellent exogenous Kitone supplements to help keep you focused during that afternoon slump. And they're offering listeners this podcast twenty percent off their purchase. If you go to perfect Kito dot com slash Rogan. You can find my favorites and enter the code Rogan at checkout. That's p e r f e c k e perfect Kito dot com slash Rogan and enter the code Rogin at checkout to get twenty percents off your purchase. Thank you also to quip they reinvented the toothbrush plays and gentlemen. They fucking nailed it. I love it. And you can get one backed by over twenty thousand dental professionals. It starts at just twenty five dollars. If you go to get quip dot com slash Rogan. You get your first refill pack for free with a quip electric toothbrush. That's get your first refill pack for free at G E Q U IP dot com slash Rogan and last but not least we are brought to you BAAs ZipRecruiter. Ladies, gentlemen. You don't have to go search and let ZipRecruiter do the search and the find and four you send your job to over one hundred of the web's leading job boards, and then with their powerful matching technology scant, thousands of resumes and find the right person for the job, and you could try ZipRecruiter for free. If you go to ZipRecruiter dot com slash Rogan. That's ZipRecruiter dot com slash R. G A N ZipRecruiter dot com slash Rogan. Ziprecruiter, the smartest way to hire. Art, folks. Thank you so much for tuning in. Appreciate you much love to you. All take care. Bye. Bye.

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Should We All Avoid Gluten? with Dr. Alessio Fasano

The Doctor's Farmacy with Mark Hyman, M.D.

1:02:39 hr | 2 years ago

Should We All Avoid Gluten? with Dr. Alessio Fasano

"Welcome to the doctors, pharmacy. I'm Dr Mark Hyman and that's doctors, pharmacy f. a. r. m. c. y. place for conversations that matter in today's guest is an extraordinary scientists and leader in the field of gluten Dr SEO Fasano who I've known for number of years, and it's been a huge contribute to our world of functional medicine, helping us bridge the gap between where we eat our microbiome and chronic disease. So he's extrordinary physician. He's been at the forefront of the field of seal EAC in gluten research. He's now at Harvard. He's the head of the division of pediatric urology, nutrition, it Mass General and professor pediatrics at Harvard Medical School, and he's basically leading huge team looking at how do we understand Celia can gluten issues. He's leading a group called him. You coastal -nology biology research center, which is over forty, five scientists, looking at how do we translate the information about what we eat gluten. Our gut, our leaky gut. The microbiome and chronic disease is pretty exciting work, and he's written extraordinary book gluten freedom which had have you all check out all the proceeds for the book sales go to support research and it's available in seven languages, which is great. So the topic's he's doing now are pretty exciting. One of them we're gonna talk about which is new research study looking at how our genes, our environment, our microbiome and our metabolism, all interact to create risk for disease. So welcome Dr. Fasano thank you Mark for him. Now you're at the forefront of one of the most exciting areas in medicine, which is this connection between what we eat. The microbes are got and chronic disease, particularly autumn you disease. And you know, I started practicing medicine twenty years ago. Nobody even heard a gluten. I was talking about. Gluten free diets are like, what are you talking about? People have to eat the worst food and now it seems like millions of people's spire to be gluten free. It's like an aspirational diet. Gluten free is kind of kind of a badge of honor and now restaurants have free menus, and and the question is really seems to be a lot of noise about it, but where's the signal here? And we've seen a real increase in seal. Celia can in the last fifty years and we're gonna dig into your work a little bit in a minute, but is the world overreacting to this gluten issue? Is it a fad or is there something there? Well, definitely there is some air, but he's also component of question about that. So it is an interesting journey that I wouldn't Verstand as you were saying twenty years ago, you know, people. No, no. How to spell gluten. So much. So defying the gluten free this gluten free many. And again, you know, the field really went far in the best when years. Thankfully, I have to say because the improve the quality of life of people that have to leave for Madigan assess ity and doing these journey. Also, we learned many lessons. We moved from the concept that the only people that belong blue free Dieter people, we see disease to the concept of the people out of than silly x. debt needs to go for medical necessity. This none Celia gluten what you've really helped pioneer, the discovery of sensitive definitely as the last kid in the block, and then we'd allergy and so on and so forth. So really the field expanded and tremendously. And would that our knowledge what Gruden dust 'twas, of course that went, you know, more than the stepped American assessing when people start to think that in threes, good for everybody because Goulden can be. Foxing for everybody and so on and so forth. So again, I think that there are some element was more than we thought, but not as much as some people phase. So you know. Noise. So the single is, yeah, the two major groups, you know, some people they need to go for Madigan assess ity either because outta meal, responsible disease, lurching response like we dodge or they f- another form amuse response that we still don't know completely don't see the sensitivity. And then the other problem logic group of people that invasive guides for lifestyle the freedom to do so. But definitely have you know the American assess the first script? Well, I've been doing this for twenty years and I would say one of the most powerful tools mytalk kit. My tricks and my trick bag is putting people on a gluten free diet. If they have any chronic inflammatory disease, even neurologic or psychiatric issues, sort of an interesting thing. And sometimes they do have antibodies sometimes they don't, but it's sort of always a one-two-three my list for trying something to see for makes a difference and it's external. How many people respond. Positively when they get off gluten. Yeah. Mark the the major confusion when you go is such a heated debate of believers versus not believers is that if you have the right primis you you clearly fuel a debate should not be there to be honest with you. So you know believers, like you see the light at the end of the tunnel and realize besides CDs, the chronic inflammatory conditions that can benefit to going gluten free diets. What is the caveat here is the no believers. They make the assumption that you know, that is a premise that has been based on the part of the see this, meaning that everybody going glue three Shufi a better because that's the culprit of the Ottoman process seated disease. What is the misunderstanding here? In my opinion, for both camps, I have to say is that while the expedition is one hundred percent of people, we see disease, they have to diet because we know that this is a fact there is the misunderstanding that the same applied to all the other chronic inflammatory diseases, my personal opinion that can be wrong, be proved wrong. As many times is that you know. I am an amino of this kind of, you know, to a streams in a sense that I really do believe that they are subgroups of individuals without a chronic inflammatory diseases, including out immune diseases, including chronic fatigue, you name it. I, yes, that may have gluten as the culprit, but not all. Yeah. So you know, ideally, and what I see this going to be the future ally in terms of best-case scenario in terms of best critic practice is to identify volume by markers that will identify this group of individuals in this chronic conditions that have gluten as the instigator and place them on free diets. Yeah. So I give you an example of while ago, collaboration with some colleagues university moments, we found out there is a subgroup of schizophrenic individual to golden. We end up to quantify, but it's still an approach. Mission that probably about fifteen twenty percent. Now those people often will have elevated any light any Bob. Alright. Yup. Yup, absolutely. And that's how we in defied them and they have other out onto this that invalidated -ly on like the tissue transplant. I'm knees six people a biomarker near inflammation. But the bottom line I'm trying to say is if we have taken the bold statement that all schizophrenic individuals benefit gluten-free died and do a trial, which congress gets a frantic and put all the free diet and only those twenty one hundred will respond. Right, right. Because, you know, you know the efficiency of twenty percent Africa. See, I told you so doesn't work. If on the other hand us threatened by the population, find the subgroup in this. The heart of functional medicine has always personalized, and you say, well, those have by Marcus the anti Glenn onto the six, this, whatever this, that tells me that chance there will respond to the for that put all to twenty you have onto percent. Exactly. Now, I don't think that is. It's really a thing considered. We're talking about a devastating disease, hopefully, very often do not respond to cut on legal intervention. You give the life back to people and you made job are dis that possibility. If you know again, you don't approach this way. So this is a long way to say, I'm not in the camp of the people. They are skeptical that say, has to be only are. Wise goons not business. You should be interesting, but the hand, I have to give a word of caution to vilify treatment. They can be extremely powerful and effective by placing everybody on the free diet and hope for the best. Yeah, I think that's really important. I want on pack that from it because there's a couple of pearls and there one is that gluten can cause brain inflammation across a spectrum of different conditions from schizophrenia. Autism also see and large portion, twenty percent almost who have anybody's to gluten depression, anxiety, ADD. I mean, all these have been linked to gluten in the right person. One of the things that you published in two thousand three was seminal article in New England Journal, which I found extremely helpful because it mapped out the fact that gluten and CLA disease can be linked to over fifty different diseases. So it can be linked to schizophrenia, but it doesn't mean that all schizophrenia is gluten problem or that all collide is gluten problem. And I think. Probably gonna medicines. We think these conditions are uniform, but they're not. There's no such thing as schizophrenia, schizophrenia, and I think this is an important concept that that you kind of lose stating with this personalized approach, dentists who sensitive and the biomarker issue I think is important too, because we typically in medicine or trained that enlist you have a positive biopsy of your small tests and the shows you have Celia act, then it's not an issue and I still see this going on, and then there's the antibody studies and it's very elevated. I think people will agree that that's pretty good marker for its TGI or any glide anybody's. But if they're slightly elevated, what's normal, what's optimal? Is there any normal? We've had this conversation before. If you have any anybody's, it means you have a leaky, got it means you've been exposed to gluten enemies. Your immune system's pissed off. That's right. So. Navigate that world is again raise on. If if we take the. Again, the strong position of debate with right was wrong, and we keep, you know, in the raider screen, what should be our focus. So what is the best thing that we can do for our patients? So improve the quality of life commonsense would suggest you that this is all know. For example, if you look at the best drug on the market, the best of all in terms of efficacy. Bets. Are you talking about forty, five, fifty, percents efficacy. These doesn't work on half the people have to pay, and this is the best drug that we have in the market. So we know ready that this are non genus, publish the design. Those are about thirty percents. That's right. So that's the background noise. So if you if you honestly keep this in mind, less learn number one, where on the only qual number two, we conventionally talk about diseases as of this nation that can be common. So you're Crohn's disease can be similar to microns east about how we got there can be very different. So imagine results the same, but the causes and imagine that you then on that premise that our believe is not disputable because everybody will agree on that. Then you go to the next step assay and I have a bullet magic magic bullet to that can fix them. All that doesn't commute. So. So that's what drug development is approaching the problem and that sense. So if you sect that these are fun of this nation and you can get there and different way you also as a Colonel Larry to that statement after, except that eventually treatments needs to be diversifying. Right. Which is a radical concept what you're saying that all diseases in a category or not the same. So everybody with rheumatoid arthritis or colitis, or it's free air, not the same, and each one is different treatment, even though the looks the same at the end of the day, and that's functional medicine. Fundamental again, I don't want to be philosophical romantic here, but you know you're in your. Just because I'm all physicians in healers of two thousand years ago. They were focused on individual trying to balance by different approach, philosophical wages, little bit of science, and then we start to really be programmatic and systematic and then look at, you know, conditions as diseases always shift the focus from the individual to the seas and conventionally we, you know, went to that path to try to be evidence based find the target to find the solutions on and so forth. Recently am not just functional medicine that probably seal this before then. Evidence made imagine, but even the, you know, the classical train physician like me, start to really appreciate that we should shift back to the individual because that's the way that I've actually you can have the best efficacy possible. William alter said, right, the father exactly. We should treat the person who has a disease, not disease at the person has. And if you got in that kind of premise, the debate is over and there is no discussion that you know, sure. We have to have conventional approaches of. We have to be system attic. We have to be evidence based, but we also need to accept with Miltie and an approach that the magic bullet is not there. So there is the lesson to be learned here that again. There is the possibility of a subgroup of individual in any given category of chronic inflammation that can be treated with a gluten free diet because maybe there is the possibility. Our challenge now is to find this people how to identify those people and talking about, you know, glued in the brain has you were into this for a long time, and this is also not Batabano even people the most sceptical people will know because they do know that seeded disease is associated. So the ones that everybody except it with near logical symptoms, MBA symptoms that I'm the pin, the possibility near inflammation. We know that you can have in on sided depression, mood swings, right? Because new information and to the point that I was telling you there Marcus in information, the most classical example in you not spew the existence. This end term. Therm walking around as inflammation battle uric when this affected because of that the same by the same token novel would dispute that city. This can give peripheral neuropathy. So inflammation peripheral of the nerve never Simpson. And again, by the same token, I think that if now you go back and say, what about people with depression, but not silly disease or anxiety without necessarily disease all pretty from new up the Nazi the disease? Is that a possibility? Because now, again, everybody seems to accept that you can have probably grew outside CB disease by transition, need to accept the possibility than your inflammation. Sexual pervert can affect people other than individuals disease. So I don't see too much of the Konomi, but there's there's an interesting tension here with the non seal EAC sensitivity. There's there's a mechanism they wrote about which is our ancient immune system. Call the anatomy in system that can react glued and there's no antibody measurement to. They're just measures just general inflammation and sort of very primitive sense part of your means. And then there's the antibody part of your mean system where the adaptive part, and that is where we get silly anybody's. But the question is, is there way to measure this silly since Nazi? Like since he just looking at ranges of antibodies that aren't quote, abnormal, let's say you're ranges up to twenty. What if it's fifteen or sixteen ten is at a significant factor to look at my own Assan series. I don't know. And the reason why, because again, we're still learning the pathogenesis Seila gluten sensitivity. I lied. I'm convinced because the cool events in the league pitcher that we're dealing with an immune response involves all the native mean system. As you said, this is an saucer away that we developed to fight enemies. You know, it's when we deploy our army without thinking who are fighting because I. I can't think about who are you customize weapons against you on the since I just need to deploy and get rid of carpet bombing smart bomb. Exactly. And again, in that sense, you will not find by Marcus little tither high there that will link inflammatory process to the disease. And fact they are several groups including ours. They're looking for by Marcus sensitive. My sense is going to be a multitude. You were looting to the first generation onto onto antibodies, their positive and fifty percent of people with not see sensitive, but that's not the biomarker of reaction to the nice we typically intend for Sita disease work, give out onto ball this. This is after the fact. So the immune response is is, is been activated. You're fighting inflammation and not what you sees a biomarker. The consequences. This War I as you were saying the individual eating, the intestine got leaks leaked Gruden. Fragments comes in and immune system, does his job is under back and some of that is not supposed to be there and be done about this against it. So. I think that's going to be a combination of civil biomarkers. It has to do with many of the functions that will lead to the inflammation process. I wanna walk back historic little bit because you know hundreds of years ago, we were eating gluten where eating we'd and we didn't see that levels of autumn unity. We didn't see the levels of of Ceac disease that we do now and you're here at the annual conference, tremendous. And you gave it a brilliant talk, looking at how we got here. One of the factors that changed that actually driving this level of gluten reaction. And my wife now is in Danny. I wish I was there with her and she and she has trouble eating pasta in America because she always gets a stomach ache. But she said she's an Italy now and she doesn't. I know they don't allow GMO's in Italy other, we'd is not GMO although they spray are we'd here glyphosate at harvest which may have an effect on the microbiome, but how do you sort of explain why we all of a sudden got this way? What are the changes that happened that make people. More susceptible. The gluten always been there is the gluten different in the we have is on the else change in our guts and environment. Like what is this driving force? You know, again, first of all, some people believe that this was just an increase awareness, but we know that it's real and they're plenty of evidence that disclu religious orders are in on a rice, and it's not an isolate phenomenon. Every chronic diseases are on a rice, allergic disease out immune disease, nudity Jaren disease, like everybody's inflamed. That's right. Cancer, heart disease high signed, an epidemiologist head, you know, hand on the fire say, we believe that that's the case and the supreme strong. So. This to say, we're not really looking at a weird isolate. The phenomenon relates Guten. It's more in the context of this epidemic row, inflammatory diseases. So. Why there is this epidemics what's going on here? First of all, the time line is is materializing is telling us that is not genetic mutation humankind. That makes us more susceptible because that takes much much longer x. generation. It's not thirty forty years has we've seen in terms of time line. So most likely were changing the environment way too fast for us to adapt and the example you were mentioning about your wife and actually I hear this mom anytime here it. I hear this all say, how come that I go to Europe about? I'm fine. Looks that I can tolerate stuff at cannot even look at when I'm in the United States. Definitely. I don't think the GMO's is the issue because you know, of course, Europe in general, a very strict regulation GMO's more much strengthen us. When you talk about grains like wheat, there is no such thing right now. He's not such a thing, but you know, there are different ways that you can explain why the load of toxic. Baptize may be higher here than Europe because of the dwarf we use here, these different. No, no, not even debt because the cultivars the same. But the way that we manipulate grains can be different. Give you an example that can be one of the many that I can give you to make breads. You Kice you take water. You take the flower. You make your dull. We as human beings. We do not have enzymes to completely dismantled gluten in its basic elements acids. What we do is a partial digestion and what is left or this under just fragments that can get inflammation. We know that most of us can Endel that will not be deal unless you go to the streams or if you eat a slice of two pizzas, it's fine. But you've three, I will be sick no matter where you are, and this applies to anything in life. Of course, even Durkee that is good for you. If you too. Much. You fell asleep and you know why. So. This process of relations. When you make the bread dough a use east east Appleton's arms, they can completely dismantle the stocks elements. In Europe. Breath is still made the old-fashioned is an overnight process. So you have ten twelve hours designs can dismantle the load of this fragments. Not hear the process takes two hours because now exhilarated officially. So you give only two hours the enzymes to. The lower so risk. The grain is the same culture. You don't know, but, but again, the way that you prepare pasta is there are processes that you have to go through the caissons drying the past and so on. It's a fourth again, give less time if you speed up the process to make this right. That's one. The other is, you know, as you were looking to pesticides, we use specifies here down that allowed in Europe. And you know, again, that changed completely landscape is now into not a variable that can affect now aid that we in terms of our immune system can react where any given product and to be grain, but it can be any other product can give you the same kind of reaction. So. And I can go on with many other elements. You know the water the way that straighted environment the pollution in the I mean, there is so much. And then of course, the great unknowns that we see. Understand because even the in United States is not on a genius. So you are pockets of places in which this phenomenon seems to be much stronger than other pockets. So gotta be some environmental situation that we still control. Yes. So going back to that, you know, the environmental factors changed, and I think in your lecture, you mentioned a lot of changes that have happened that altered a different thing besides the food. So there's the quality of food how we produced the food, all those things in terms of traditional methods, it may affect people's sensitivity, but you also talk about the changes in the gut microbiome and you. You're originally came into this through an cholera. That's your sort of coming back to it. Looking at wait a minute. Why are people so sensitive? It's not your sensitive to gluten. Let's get. Why is this happening? And and house are changing our environment, toxins, stress, diet antibiotic, c. sections. How's that? Led to this increase in autumn unity, increase in seal EAC disease, and allergic. Inflammatory disorders. So if you really want to look systematically the environmental factors that eventually fuelling this epidemics now that again, we agree that this where we have to focus our tension and not the human beings genetically speaking. Because again, we didn't mutate such a short period time. You start to really question what up in the best fifty sixty years. It was different from the previous generation where we didn't have this epidemics and of course you're losing some of the factors. So. You know our lifestyle, you mostly were leaving your rural out of style, you know wanted to generations ago. So living vicinity, animals. A lot more Migros. That's right. Have Reidy but you name it parasites viruses bacteria, but there was a full exchange and again, we make again, this other convention that we are is elated Zeila in terms of environment, we are in a continuous sequel life, so soil animal Uman back to soil and the waters. We conventionally analyze them separately, but a unified ecosystem. And you know, again, if you believe that and you just human beings, make the statement we didn't change much through, but what about our soil? What about our water? What? What our animals you know? What about, you know, leaving in a crowded environment versus. Sparse environment, you know how this changed the dynamic of what's going on. And again, you know, now that we have to that we didn't have before we can understand, this continues ecosystem what we exchange. So the most important thing that which are microbes and microbes are integral part of where we are now. We know that only one percent human right most. Genetic speaking, that's that's definitely the case and you. We are whatever we are because we quibble with microbes is not that we talk him ways. Right. That's right from Mars. And then all of been exposed some than ever seen before we look an act and are shaped the way that we are because we have all with this ecosystem. Now, again, that s- you know, when when when we ask ourself, what kind of changes we mate. The stuff that's visible. So the heiress polluted and other is fog or the water looks dirty lawing in fruit but problem not the driving force. Is this parallel universe that since through mental for our health that changed medically microbiome nocco Buyum. So in other words, you know, this community that is supposed to come in orderly since we're in one and stay with us until would die. That has been completely. We've Lucien is in its composition and function that mesmerize are that we are not make even more dramatic changes with seen. So that means there is some terms of ability, but I can't emphasize enough that change in lifestyle from rural to urban introducing antibiotics for treatment, infectious diseases into. Reduce new practice like the c set showers one third of all births now. Well, it depends because I just was in Mexico for a meeting and I learned an Mexican section is sixty percent of the population that sixty ninety two percent in Brazil. So it's staggering ninety two propsal and again, I welcome with option checkup ABC no, Mark. The reality of the story is in a lot of hundreds of thousands of women's died because of her true. Exactly. So see section has been tremendously important events in medicine when I medical indicates. But when the OBGYN will prescribe a c section, so he or she can plan vacations or cash more money in or. The woman decides to go see section for our own needs, but not because. Necessity. I will suggest to think very carefully because again, the plan of in grafting and growing the proper friendly, Marco bio is being planned for two million years to be done to deliver. Yeah. What absorbs through its mouth all the vaginal colonize? Scott solely. And that is a Florida that is been highly selective, my mum to be genetically compatible with her and therefore her baby, the skin microbiome. It's not selective. They are all comers. So the operator in the operating room or the nurse, or the honest microbiome coming there and may not be friendly for the new baby. So, and of course, you see more allergic to seize as MMA. Absolutely. Because no matter with you about three NATO factors mums lifestyle mums environment or the like the C-section or about exposure or the way that you feed the baby breastfeeding three thing about offending or postnatal all this named binge on the composition and function of the microbiome. Why? I'm so obsessive this first because as you said, that's where I start. You know, my science from the very beginning was totally focus on understand how microbes stay crosstalk with us at the beginning focus on a single package into understand how they make us sick, then that knowledge moved to the community. And now the ecosystem that now we call microbial but the game, we're studying this twenty years ago with tools ridiculous compared to the ones that we have right now. That now clarified the complexity of the matter. And we're just really at the infancy of this gun most definitely. But again is giving us the paternity even more to appreciate how singly we are, how different we are from each other, how eventually, you know, loosen tolerance, develop an inflammatory process can be so different from one individual or even if again, we end up within the c.'s. Interesting. I treat a lot of patients with flute issues and seal Z's and often I find they don't get completely better when you remove the gluten. And then when I put them on a gut restoration program, really getting rid of the bad bugs and putting good bugs, just simple function as principles which are not really that well established scientifically, but we've been using for decades. There's help normalize function, then they get better. Have you seen that? So we and others published that even if you're reclusion free twenty. Percent of kids up to forty percent of the dolls still have inflamed gut, not because they cheat, but because again, there is no repair. I don't know why most design is because in averts in exposure to cross contamination outta times because again, there are situation which the misison is either belligerent. So if I say, you know, clearly I understand what's going on the answer, no. But again, I would be this missive if I were not consider this either belligerent in this individual that are not able to repair inflammatory process to be totally unrelated to micro biomass function. Well, it's also interesting. The way I think about it is that the gluten is sort of the gatekeeper sort of opens the gate in creates this leaky gut, and then all these other food antigens can leak in and start to aggravate the immune systems. Begin starter react to other things, and I seen this over and over the decades this something you noticed? Yeah. I mean, again, I'm quoted all the time about this because you know, our group was one that scored the molecular mechanism by which gluten can really make curtain tests and leak through the release, a zone. This molecule that is been Netanya Netanyahu. That's right. Linked to a variety on prize for. People are still very skeptical, so. But any the bottom line is that you know. You know and you, you put two together saying, well, if Gooden is capable through some of these under just peptides to engage on a specific receptor, instigate the cells to release zone land and make this leak than this be that mental armful to everybody. The answer is the band's actual. The vast majority of people will not have consequences if you have a balanced diet and can even be useful to help. We call antigen sampling to to, to bring very small amount. And so immune system will be more robust more a bust trained in case the storm will come. The real deal will come. The problem arises when you exceed the amount of gluten, for example, so that contains all the time or even if you're not a huge amount of you're genetically predisposed when you increase per mobility. On the other side of the fence, you find an immune system that is ready to fight against gluten. And this other. People have been really disorders. So all this to say, I will not cut guys. Gluten has the villain at twenty first century necessarily. After all, if you and I were here running, jumped from one three and other, we have to agriculture that predicted the amount of food that we can have and free up our time to do more creative stuff by the same token to dismiss completely the fact that Glynn can be an issue for a variety of individual outside CD disease that will be also to not see would become more and more obvious. Yeah, it's pretty. It's pretty strenuously how this whole field opening up and one of the things we are were made fun of for decades idea of leaky. Gut that basically the belief was that if you had elite gut, you have sepsis and you die basically which means you have roaming infection. But this sort of intermediate zone of sort of slightly leaky God leading inflammatory diseases seemingly connected to. Everything from obesity and type two diabetes, heart disease to autumn indices is neurologic diseases autism. I mean, it's sort of it's like almost as unifying theory of how we get inflammation. So I'm fascinated how Stargell memory is lost doing generation. So for example. The of called a measure, whatever. But you know, when you know at the beginning, the nineties, we were convinced that was a big deal in. I states the the subli- -ment really came after us be time. You know you, you really miss the boat. Here we look for, we didn't find it. So you know, you're you are not, you know, in the right direction and this very much because the criticism were very much more harsh than that. And again, and their premise was on state of mind that was fixed on what was that time. The definition disease young kids with be belly I rea- through and we don't see that we don't see that we see other stuff and you don't have to have any Justice systems zero. You can be Abe's, but that was not clear that time. And that's why we were highly criticized. Now in two thousand eighteen. If you ask anybody mutt nutty. What question that disease is frequent and the United States and in Europe. But if you ask is been always like this, the answer most? Yeah, of course. We always thugs even the ones that were hypercritical same phenomenon. Would this leaky gut story? You know, again, I, you know, I his not that I was like a functional medicine doctor always tune in. I came to this by chance by again doing this cholera vaccine and learning. The color can make your leak. And then try to understand how does and see a very sophisticated machinery to loosen up the increase in permeability of digestion in intestine and then the little connections. Yeah. These gates in between cells that we thought that were cemented so that no, no things can come through cells, not betray. That's right. Has everything that we negotiate. With environment without has to come through the cell, and then we'll learn no, actually space in between cells can be modulated in its permeability, and we started the stocks and we saw this very complex machinery reasoning that I made. There said it can't be that we evolved to this machinery there just to get sick with this toxin from the cholera libra probably learned physiology from us and exploited that possibility for its own return. And that's how end up to the scored zonalin. And I have to say, you know. With the story of the league are now half a way compared to the stores diseases over the discussion. I say away because even establishment now of evidence based medicine, the hypercritical our work that has been coming right here to. Vein, when we discussed right track when you're. Again, Mark, I again, I'm a an individual that not only I'm open minded, but I, the individual, you know, I have met that science is a constellation of failures were very few successes a, you leave for those, but also the sciences perfect path. Most of the time you're wrong, and there is nothing worse as a scientist to not omit what you're wrong. You know you do is you know hatch, their ideology. What is to today will be garbage in two years. We know that that that dynamic. So as a good sign, this you formulate an parts you design and experiment challenge diapers, and you perform the experiments, and then you've violate the outcome that nine out of ten times is different where you disobeyed with your formula that I, this, this brings to kind of science incremental science. I want to go from point eight to be to see to to to my final destination. I know where I am. I see my sites where I'm going. That's the one in which you're Pierce will follow. You will understand what you're doing and eventual, except, you know the approach that you're taking because everything is clear. Sometimes you want to go from point eight to point be a you end up to point z. so in a place where number he's been before, most of the time is dead ends. So it's it's something that leads to nothing. Very few times. You got more, we call transformation of science. It's not something that you intend, but by and up to be in something that completely depowered. I'm away of unintended consequences of your, and that's what it's on. The score was all about when you got there to understand if you're dead hand or you do something transformation. The only thing that you need to do is to seek and see if you're Pierce, can validate every produce what you've done or this was not reproducible. The zome story now is highly produced. A matter of fact, I don't, you know, auditor the vast majority of what is the signs on. Now days. We can't view the meniscus component of the. Hundreds of papers out there all this to say that not only zone story, but the story of the motivation, GOP him ability with the identify of genes modulate Taichung since the indication that lost Barry function is the core, many, chronic inflammatory diseases. People are coming around and it's so powerful yet as a. Sort of. Disciplined medicine is not really thought about how do we address that? How do we fix a leaky gut? How do we normalize the function in there? What do we do to fix that problem? Well, we can't because we don't know yet why mechanism deletes to that because this is a very complex machinery with very sophisticated functions. And that was mentioned during the lecture that the structure, this type junctions is still imile done. That means it's a function. It's a dear to us because we're redundancy means that you know, you have back a lot of backups, Sebastian. I can tell you grit level confidence that the two key elements that makes you tested leak is one Gruden as we said because release zone through this mechanism and am balanced mccrone where we call this bios. That can be either because the function and composition is imbalanced or because the microfilm is establishing the place where it's not supposed to be small intestine, but your growth CBO is one of the most way over to release zone and make into this all the time. I call the food baby bloating. After ended in that often means there's bacteria and they are producing gas, and that's right. So I think that you know is going to take. Not a few years for people to accept completely this idea of the importance of intestinal barrier in a variety of chronic inflammatory diseases. So the hearts of soul of immunologist vision knowledge will never come around us that will never come around to the idea that out immune diseases can be treated as are believed that they can't. Because if you start this thing got, of course, you know, which is not. We do it in functional medicine, not even knowing what we're doing. This conditions, including in this is our based on five pillars, the genetics. So who you are your environment, including you eat in increased gap ability and immune system that becomes eyebrow Durance and a macro by home that is not doing what is supposed to because epi genetically will make your genes to be either spread or repress. So they switch from genetic disposition to kindergarten. Eighty and when I running inflammation anything, yeah, you know, cardiological issues. Arthritis fry might go by on any anything. Anytime, knitting, any of this five pillars are fair targets to try to meteoroid inflammation again, genetic editing. I don't think that's a possibility because the complex is way too much. It's too many genes involved in that is going to happen mobility environment that something that we should really deal with all those pillars in medicine. We just try to find the one drug to fix the one. No, it's not gonna work that way. So if you will continue to have an environment that is really conducive, OMB inflammation, foods, pollution chemicals, you can fix whatever you want in terms of Munis, oppressors or change the micro, everything will go there. But if if you start to think. More, I would not say Listrik comprehensive, say, let's start with so lifestyle really is a common sense. Of course, we can go back and leaving a cave that's not feasible, but can we avoid some chemicals that can instigate inflammation can we eventually decided to feed our kids food and other junk that we feed so that eventually have the same chance that we had? Can we promote blocker production of produce rather massive production? That of course come with a price that that's, you know, agricultural system, our food processing, and again, you know this, it's an uphill battle because you against major interests of course. But if you do that, then you can tackle how can I fix a leaky gut? What is the problem is this bios can then use prebiotics post -biotics pro by all these symbiotic, whatever. It is. Whatever it is and then you know, then. That's got also to the point of this bios because again, the they all interacted very powerful in your talk, which is that the single biggest thing we can do to change microbiome is changed the food we and the quality of the food we eat and get off the processed food and eat more plan, rich foods, and good quality foods, right. If you think about this, five dealers just told you they highly interact. So if you affect foods, you affected the composition microbiome. If you micro back balance where supposed to be based on our Lucien plans, the immune system will defend us rather than be beligerant gas us, and we'll finish inflammation all when I definitely need it. If you were a balanced microbiome, you also will have a gut permeability. They will go back to the way this supposed to be an a good gut permeability will make them you system to be less login. So it's all interconnecting. So you said something to me about a year and a half ago. That has just resonated in my head and I don't know if I got it right. Which is that in your work, you discovered that anybody gluten has some change in their permeability even if they have no symptoms. And to me in my simple mindedness, that means that anybody is going to generate some level of chronic inflammation. Did I get that right around? I don't think so. Again, as I was telling you watch the majora people debt, you know, have you know this crisper mobility Fulla by again, a very tightly control inflammation, there is good for us. I mean, you know, I'm Augusta, Allah gist. And if you little bit of a poison is good because it helps. If you look at the gut of anybody, I've been in this business longtime and never seen in a biopsy of a human being gut with no inflammation there. He sold information there all the time and what we defined inflammation in the terms of a scrutiny of mass of immune cells. They are really, they're ready to fight to colitis. It's just a low raise those. It's a low grade signed. You've got your military and they're ready in the front slack that you have athletes their training for the Olympics. Don't train just the day before to deal in this day. They trained for the four years before. So that one is the time they're really invest the best shape possible. So the is in the entire guts and not just a colon isn't a chronic state of tidily control, healthy, low inflammation that is local goes nowhere, but it cleared. That condition which you ever baseline situation that is radio training fight. That's right. So training camp exactly the problems arise when this inflammation goes to the next level spill out the and go somewhere else that's worth the problem. And that is when that tightly control gut permeability. Because again, if you have a gate, this will be open and close all the time. Gruden is one off the many reason why we can open close this gates. It's useful for us to do that if was not useful Madam, nature will put the wall the gates. So the fact that Gruden increase per mobility to everybody. It doesn't mean that everybody will be in trouble. There is a subgroup of individual definitely got in trouble and of that will not. That's reason why I will not them Nuys Gruden necessarily. But at the same token, I would not this miss the possibility that the diseases we've been saying for almost the entire. Casts here, there is the possibility that there are people that don't have the disease. They got in trouble because of gluten that increase the up regulated up, regulates the Zona pathway, create a shortcut for other junk to come through and maybe into get. That's right. One of the things I ran his true is that in the in the effort to increase food production, we hybridize and Brad, we'd to contain more starch and to be shorter and drought resistant and grow better and produce more carbohydrates, which is dwarf wheat. And in the process we combine the genes of different weed strains which led to more gliding proteins in the door fleet. And those land seemed to be more of the ones that trigger inflammation is that part of why we've seen this increase? I'm not an agronomic, so I speak saying on hands for would I learned mainly boy, say a meeting that the National Academy of science. Actually lean in Washington DC a couple years ago to which I was invited. So I had the opportunity here the agronomists. There's been such a shame. No question about that. So Romans and Greeks, the used to eat a very tall. Weeds. We eat is not the we we ate, no, absolutely. But was it told plants only five percent of the top had seats four percent of the dry weight was gluten at that time. And then later on during the renaissance of we increase the, he'll to make more produce a useful wheat by doubling the amount of, you know, granted there. So from four to eight percent, and then the less relation was doing the agricultural revolution that we're this, your. We one third of the plant now is seeds. So the efficiencies much higher and now we're about twelve percent rather than four percent. As we start the thousand years ago. The epidemic that we have seen materialize after this event. So I think that is the Coulter ours that have been pretty much fueled by farmers to he'll that's what is is fueling the epidemic. I really do believe that is more the way that we handled the products. And you know what your wife experience in Sardinia is testimony that it's not that the genetics and the load weeds. Gluten, which is called personnel, like it's more ancient string. Well, of course there's going to be less gluten endear Anchin grains can be beneficial. For example, if people don't see the sensitivity like Lauren, we, that's right to decrease. The load of Goulden will not be beneficial for Silva acts because no matter was four percent of twelve percents, it's way too much fascinating. So one of the things I think people who are listening were wonder about as when when the introduce gluten because there are a lot of women who have children and were were fearful that if we just too early look promptly interest too late in my problem, what's the Goldilocks rule here and shoo shoo would be abiding and kids completely. You know, we asked this question when we're trying to understand what is feeling this makes and a matter of fact, we did this by first of all doing a woods Colin introspective. Cochran analysis. So looking all the studies in the literature and try to find out, you know, is there any hand there and the he where maybe the breastfeeding practice degreasing is the culprit or the c. section is the problem or the interaction at large amount tour ily life. And that was the premise that Simpson's jets. These are the kind of wreck shin that we have to look at. It was out of the question and still applies that if introduced gluten way too early before the three months of life, you increase the chance. No question of prima wait for your, but but was not clear for this respective studies is if all the current condition, the Americana pediatrics between four to six months are we really increase the chance of having probably disease. What about if we spawn laissez euro. So we allow the system too much and be able to handle this better. And we did such study. We've perspective full of seven hundred neonates a risk for Assyria disease because someone family had seen a disease for ten years. So it was a longest shitting journey to. There was published a couple years ago, New England in medicine, the lesson that will it was. You know, very hard one. I have to say nothing Pinella to be rights based on the richer, sweat to studies. So you couldn't find a pattern that connected. So if you delay a twelve months of h, you delay the onset of disease, but the final destination. So the frequency was the same incidents was exactly now you can argue that the lane the onset Z's allows, you know, marry important organ like the brain developed develop better and be protected against, you know, this hit of inflammation but is not a preventive approach, c section of difference breastfeeding about a the make defense. Am I saying that these are not important factor? Absolutely not, but teach me and not a module important lesson. You know, again, as we have to deal with. Patients and not diseases. You cannot deal with individual factors, not then has a whole. You have to look at the entire situation and the presentation Communards of some of the data of the next generation starts disease, Gemstar edge. And you know. That is wants that we are doing to try to find out why some people receive the disease keep straight and stay health in some the renter is teaching us that lesson is the combination. The above is not a single one. It can be c section and about, oh, fitting can be -biotics right treatment, and you know, exposure to whatever environment. Factors. But, but again, all this to say that, you know. The single element and change the single practice by say, postponing. He's not. He's not gonna work. We'll solve otter. Intervention should be as important, maybe. So doctor Asano you were appointed king for a day and you could change anything in healthcare science medicine, food. What would you do to make a better place. Well. I, I would take the. The monotony approach when we were Manhattan project that's rights. So when we were doing World War Two at the critical moment. You know of the war, you know, Germans were building nuclear bomb gem was the verge the nuclear bomb and day the leadership of the allies realized that this will have been tilted point. So they established the match project. Take the best of the best luck in the row. Tell them what is the problem and on. Let them out until they come up with this is that we need a Manhattan project here. So President Obama did something like this called hundred people in Washington DC just before wrapping up his presidency. Yep, scientists. You know, leaders in industry nonprofit organization like the Gates Foundation, the Robert Johnson foundation, major thinkers of goernment officials from the food Drug administration, US the the NIH and they he locked us in this building, say, you know, we invest a Yuji amount of money taxpayers money to do the genome project, not human microbiome project, but healthcare is broken. Winnie the solution here. You need to tell us how we can copy the lights all investment so that we can really improve the quality of people what is needed. And again, if you continue to approach health care as a business, so that lobbyist goes Washington DC, push one direction and not as a social service will never solve the problem. So no king can be able to fix anything here because. Fix Lilius convene in my book, the civilization of country is measured by two metrics the way that you educate your population and the way that you take care of it, healthy Weiss, and we do a miserable job here. So I'm afraid south. So I take out the education piece because it's not my expertise. But in terms of healthcare, it will take a Manhattan project. I love that idea convened the best minds in the world to solve the problem of healthcare and food and the food system and change the way we do things. I love that. Absolutely, because the gain, if you would be, if you will be from another planets, if you'll be mashing and you EV zoom, you'll down here. You'll be very powdered. So because you left, you know, the industrial countries spent, you know. Twenty percent of their Gino. Well, today spent forty billion dollars tweet more than they are supposed to and other twenty billion dollars to advertise to eat more. Yes. And now the six million dollars to lose weight going to the gym or slimfast whatever it is. Yeah. Decide the right inside people, they die of survey ship, still they do and said it would take a fraction what you're spending their bought a way. I didn't computer the costs of treating, you know. Diabetes, Arthur sclerosis, heart attack near the generation and so on. It's were dick, a fraction of their price put over there, and everybody will be much better off a Manhattan project should look at the global aspect of the story. That's actually great. I mean, actually, I, I'm trying to convene a commission to do just that to look at our entire health food system and how we got here and how we get out of it and bring all the key stakeholders together because without that, I don't know how we're gonna work on this and it's true. We gotta get the money in the egos out of the system and figure out how to solve this humanity. Well, that is a beautiful goal thing. Dr. John, thank you for being on the doctors, pharmacy a place for conversations that matter if you like this podcast, play subscribe to it and leave a comment and share with your friends on Facebook and Twitter, and we'll see next time on the doctors pharmacy.

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Episode 110 : Tommy Wood talks about nourishing developing brains and the importance of metabolic health

STEM-Talk

1:17:07 hr | 2 months ago

Episode 110 : Tommy Wood talks about nourishing developing brains and the importance of metabolic health

"Welcome to stem talk. Stem stem talk. Welcome to stem talk for introduce you to fascinating people who passionately inhabit the scientific and technical frontiers of our society. Hi, I'm your host on Carnegie and joining me to introduce today's podcast as man behind the curtain Dr Ken Ford, Agency's Director and chairman of the Double Secret Slice and committee that selects all the guests who appear on stem talk. Hi, Don. Great to be here. Our guest today is making a repeat appearance on stem talk Dr. Tommy, would a UK trained physician who is now a research assistant professor of pediatrics in the University of Washington's division of neonatologist he was our guest on episodes forty-seven in forty when we did a two part interview with Tommy. So back in February Tommy a very popular talk Jim sees lecture series about the components of building and preserving brain health across our lifespan, and so the double secret session committee thought it would be a great idea to have him back on the show and his lecture Tommy touched on ways that we can maximize health developing brains things we need to consider if we suffer from an acute brain injury and also how to maintain a robust brain for decades as we age, and once again, our conversation Tommy was so long and wide ranging that we have against split his interview into two parts. So in today's. Episode we'll be talking about the importance of metabolic health especially as a way to protect ourselves from covid nineteen we touch on Thomas work at developing accessible methods to track human health and longevity, and also his research as an assistant professor of pediatrics at the University of Washington where he studies ways to increase the resilience of developing brains. In part two of our interview, we talked to Tommy about his continuing research into lifestyle approaches aimed at improving health span N. lifespan, as well as physical performance. We also have a fascinating discussion about the physiological and metabolic responses to brain injury and their long-term effects on. Brain health. So. If you listen to our earlier interviews a Tommy, you might remember that he received an undergraduate degree in biochemistry from the University of Cambridge before obtaining a medical degree from the University of Oxford. After working as a doctor in central London, he moved to Norway for his PhD work and then to the University of Washington as opposed sock alongside academic training Thomas Coach. Athletes. In. A. Multitude of sports anywhere from weekend warriors to Olympia NHS world champions his outgoing president for the Physicians for Ancestral Health Society a director of the British Society of lifestyle medicine and sits on the Scientific Advisory Board of hints that performance which includes developing performance optimization strategies for Formula One drivers, and as if this isn't enough Tommy to do he's also visiting research scientists here at. So. As you can see, we covered a lot of ground with Tommy. But before we get to part one of our interview, we have some housekeeping to take care of. I we really appreciate all of you who have subscribed to stem talk and we are especially appreciative of all the wonderful five star reviews. As, always, the double secret session committee has been continually and carefully reviewing I tunes Google, stitcher and other podcasts APPs for the wittiest MS lavishly praised filled reviews to read on stem dog as always if you hear your review, read on sometimes just contact us at stem talk at IHS dot us to claim your officials them talk t shirt today are win review was posted by someone who goes by the moniker win Sir Four. The review is titled Brain Candy for Science Junkies. The review reads. I i. Ran Across stem talk when I was checking to see what was up with Dr Peter Attiyah, I ran across the very first podcast by stem talk I immediately subscribed and took a deep dive into the archives a WHO's who of names I could not wait to hear I was suddenly lost to my wife for several days is I binge listened to many if not most of the episodes while doing yard work, this kept me from being accused of antisocial by wife. In made my property look better than ever for those who complained dawn in Ken, our scripting to me it shows preparation and for that I'm grateful. Well, thank you so much for Windsor for anytime we can help them what their spouse family or friends were definitely more than glad to help and you have given our listeners another reason to tune to some talk it can not only improve your brain, but also your yard so I'll have to take that into consideration as well. So that was a great review wasn't again yes it was and we really appreciate all of these wonderful reviews and now unto our interview with Dr Tommy would. Stems. Stem time talk stem talk. Hi Welcome to stem talk I'm your host on Carnegie's and joining us today is Tommy. Would Tommy welcome back to stem talk. All right. Thanks be back and also joining us is Ken. Ford. Hello. Don. Hello Tommy Welcome back. So Tommy since covid nineteen is at the top of everyone's mind right now. I'd like to start by asking you about. That you a colleague recently wrote an innate you point out that is becoming increasingly clear that underlying conditions associated with sub optimal metabolic health appear to be associated with poor outcomes in patients with covid nineteen, and considering the nature of these underlying conditions that include obesity and hypertension. You argue that lifestyle based purchase to protecting ourselves from covid nineteen are to be one of our best tools in addressing this ongoing pandemic as well as in future pandemics. So can you give our listeners a summary of the key points that you made in that article which is Great. Article by the way show. Thank you. This is a an editorial I wrote for a new journal called lifestyle medicine with a friend of mine and colleague Government Johansen. He's an Er physician in Iceland and he has an increasing interest and expertise in Imia metabolism. So the sort of intersection between metabolic health and immune function, and if you look at pretty much any data source that's currently available this suggestion that those with beastie metabolic disease, those conditions that you mentioned, they have a worse outcome in impatience with Covid, nineteen and if you look at previous, let's. It's been less widely publicized, but you see the same thing for various strains of flu h one n, one swine flu, as well as previous saws and Moore's should occur viruses sort of preceded sauce Kevi ends. In people who have disease as well as with aging you see this change in how the immune system function. So you have don regulation of the adaptive immune system changes in t cells. Cell populations decrease and you also get a relative increase in the activation of the innate immune system, and what happens seems to happen is that you get a slow initial response to an infection amounts of proper response to clear it. But then later you get a much larger sort of compensatory response to the virus. And this may be part of the sites kind storm that we hear about, which often happens as a second phase of the disease, and so this happens in disease and those a group who have significant expertise in bottled to age also a paper or is currently pre print talking about Kobe nineteen as an emergent disease of aging and changes kind of converge in metabolic disease, an aging, and so in this paper or or editorial we we make the argument that if you want to prepare for future pandemics, obviously, we're thinking about a vaccine development testing through having a pipeline to respond to whatever the the future pandemic going to be an some. People think it's most likely to be a strain of flu rather than a corona virus on top of that, you need to try an improve the metabolic health of your population. If you want to maximally reduce the morbidity and mortality, we talked about lifestyle medicine. That's kind of the current best accepted term that covers the idea that sleep stress and movement and social connection all those a key to health lobby about Las Islas on the podcast, and we certainly not the first people to say this. This is this is definitely become more and more publicized that these metabolic diseases are associated with whereas outcomes and found interesting because it's been some pushback by. Other people who say that it's targeting or discrimination against those I would pull health but but that's certainly not the goal and when this comes out, the be an accompanying editorial by the editor in chief who says, the messages is actually quite pulsing I believe that's the case. There are a huge number of tools and strategies many of which we'll talk about today I believe you can use to improve your metabolic health and I think is really important to be agnostic to those tools because so many people have different things that they want to do or the they might want to change improve the health and as many things they can do. To, do that and one problem with lifestyle medicine is in the US. Particularly it's associated with the American College of Law Madison, which is very dogmatic awards plant based Diet So so we make the argument that they're actually a wide range dot was it always comes down to thoughts rewards, but we argue that there are multiple different ways to skin this cat and we should be to that and have all those options open. However to make this, happen I, think we need a better combination of digital health tools and better education and implementation healthcare system. So at will require some some kind of significant investment process to sort of get these ideas. and. The help to the people who need it. As part of this future pandemic preparedness as we called it. Makes Perfect Sense. So Tommy when we interviewed you a few years ago, you'd just become a senior fellow at the University of Washington and we're in the process of moving permanently to the US and when we asked what brought you to the states you said in the Sa-, quote a girl. Well, we know that you ended up marrying that girl who turned out to be Elizabeth Nance. Who is Clare boothe lose a assistant professor of? Chemical Engineering at Washington, and we interviewed her on episodes of one of some talk love that stem talking of you as well. In addition to you guys getting married you've also written papers together. So is it safe to say that the two of you get along really well because a lot of time together from professional to personal Yeah. Yeah we we do. Absolutely. We get along very well as hopefully expect. So yes since since master. Bad if new woods didn't get along. Together. Yeah. It would be bad. So so luckily, none of that but this is since those lost on stem told we got married we've published if you pay together submitted several grounds together so I can safely say she's my most important collaborator and pretty much every area of life I love that. So congratulations to you guys as well. You know are a research assistant professor of pediatrics at the University of Washington in the division of neonatologist, your focuses on ways to increase the resilience of developing brains really interesting important, and you also look at ways to treat neonatal brain injuries. Can you give us a quick overview of your work and then we'll talk about some things more detail. Yeah, absolutely. So the majority of my academic work has focused on investigating how Nina the brain response to injury, and then waste treat those injuries and most of this, I do and models and one strength of the neonatal brain injury field that I really like is there was a wide range of complementary animal models, which we can then use to find a treatment or examined process across all species before we try and translate it to humans I think that's lacking from from other areas of Jewish science like we talked about last time most of. My work is focused on developing ferret models of brain injury, and now we have successfully developed a wide range of reproducible models that really depend on my life period or the type of injury that won't study. So he can premature birth we can look at brain injuries at full-term. So Paranoia succeed problems during childbirth all we can look at pediatric adolescent traumatic brain injury and as I spend more time working in these areas, what's become really interesting to me is how these things by interacts over time. So what happens if you're born prematurely and get? On a football field twenty years later or does your early life brain injury ulcer susceptibility to two things that might you might be exposed to later in life like your diet or if you're an athlete and you get a concussion, does that change you'll? See to another injury later or if you're exposed to HYPOC, Sierra shoot you then more or less susceptible and these kind of questions I really hope to dig into the next few years. Fantastic Tommy and so when you give talks, you'll often start by giving a disclaimer which says, many of my best ideas are stolen. Like so when you're looking for ideas, what are some of the best places that you like to visit? Yeah. Yeah that's true. I think of when I spoke. Recently accidentally said that most of my idea is a song which. Is True. There's a slip at the time. I try not to actually steal and with much give credit to the people who inspire them in a hope unusually successful at that. But I'm I'm really lucky to have a rich network of friends and colleagues the approach problems in different ways. So the first thing I do is trying to make sure that I learned from each of them as much as I can i. will try read quite broadly because you never really know where inspiration is gonNA come from. But at same time, it's also important to realize that whatever bright idea you think you had has probably been hot by several people before you You know as they say this, there's nothing new under the sun and I think that's just a of life. This is one reason I. Really. Enjoyed delving into the literature from several decades ago I think there's a huge amount of impulsive physiology she work that was done in the fifties, sixties and seventies, and the love is really signed to see a revival now but we think is new ideas but she people were looking at a long time ago I do like to use social media as a tool just to kind. Of follow interesting research because that sort of it's more likely to pop up quickly there but I think it's also important not to fall into an echo chamber of all the people who you agree with on a certain topic. So I try to embody or of the words of Dudley Field Malone who supposedly said, I have never learned anything from any person who agreed with me. and. I don't think that's true all the time but there is a huge amount you can gain just by following people who have different ideas to you downside then is that you have to sift through a lot of stuff that you really disagree with and then not try and mount an emotional response to it but overall I think there's this benefit for that like a lot. So when we interviewed Elizabeth, she said she can't stand to look at your computer because you have so many windows open at one time I have to. Say I'm guilty of that as well. So I feel better knowing that Tommy she said that you're constantly reading paper after paper after paper, and then it makes her dizzy look at your computer screen with all the tabs of windows. So can you talk a little bit about your research methods and how you go about collecting material because in this day and age we know this overabundance of information that are way just being able to sort through everything is tough. So be great to hear how you do that. Yeah absolutely and I learned. Jury my PhD to not. Make myself feel like I have to stay up to date on every topic. Because that way lies just complete insanity. But there is some method to the madness, the disease. So I'll keep tabs and website pages and pages organized by topic in grouped into a process. which anyone time is probably multiple papers, grant proposals to the kind of like groups together. But it definitely looks a little overwhelming to begin with and I did actually have a friend and colleague recently joked must keep my tabs and processes open. It ought to create some additional cognitive load because otherwise I would just be too productive. So that's what does that that. Might be happening. So Salva Israel's to casting, which is a fancy word for random. But. One interesting thing. I've noticed about myself over time is that of changed the way the I sort of engaged my brain to remember things. So if you're a student as an undergraduate sort of had to remember all these, all these facts are you have to be able to regurgitate them in an exam but now I focused less on remembering facts and I remember where the information is. So if I just have a small snippet of an author or title of a paper or something contents, and then I need to go back and get information as much easier for me to find it so I find myself remembering where things rather than what things Make sense and indeed, and that seems to be Remembering where things are seemed free? The current trend is people's heads are essentially empty. Your current research interests, as we've started to discuss, include the physiological and metabolic responses to brain injury in their long-term effects on brain health. In addition to this, you are also working to develop usually accessible methods to track human health performance and longevity three topics of great interest here, and you know it's that's quite a wide range of interests and we'll talk about some of them in today's discussion but out could give us sort of the hundred thousand foot impression of this. Absolutely. This is one of the best parts of my current job, which is that I can essentially work on anything that I find interesting and some point is speaking to come relevant to. All the other things that I do or at least I've seen that happen again and again. So I'm also fortunate that some of my previous work with athletes and those trying to optimize health and performance led me some of my current consulting work, which is where those aspects of tracking health and longevity in an affordable manner scale a happening. So kind of separate to my former Democ work but certainly, quite relevant because when you look at things at the forefront of longevity aging research this could be tracking methods. Oh interventions actually they often become relevant to treating you the needs, neonatal brain or other brain injuries. So I've certainly seen that with keystones and. You know all these other factors that we've started to see become sort of cool in in the anti-ageing space while on the face of it certainly seems like collect a variety of unconnected interests I do think that doing each one me a scientist in the other ones the downside is that this often causes raised eyebrows informal academic circles where you know your junior faculty and you're supposed to only cultivate one area of expertise and if you. Publishing multiple areas they think that that means that you don't know what you're doing, what you want to do or who you are as a scientist but I'm very lucky that the people I work with particularly my division chief at the University of Washington. They have also have very broad range of interests and they see the importance of drawing on multiple fields and I think we're starting to see the benefit in our research in the lab. That's fantastic and so it's kind of going on that theme as a neonatal neuroscientists he work mainly with newborn babies with brain injuries, but you also work with football players and Formula One, race car drivers and work with people with Alzheimer's disease. So those people who specialize in brain research is we've been talking about will pick an area near Natal or timers to focus on you however seemed to be more interested in looking at the brain from cradle to grave in across a wide spectrum of different individuals in different professions and actions. So why is that? So the the simplest ulcers because I find all these things interesting I want to do all of them. But but in reality. I think there's a huge risk in silencing research based on a single diagnosis of disease, and that's particularly true in neuroscience and we look at the treatment of neurological disease a hole. There hasn't been a significant step forward in disease treatment essentially for decades. The last truly innovative thing that came to the clinic was the tripped on drugs for Migraines in the nineties. So between thirty years since we've had true improvement in our treating neurological disease and we're still left with nothing for. Multiple. Sclerosis Alzheimer's disease most other neurological conditions and as analytical techniques improve and the complexity of the information we have increases is very east to just assume that I'll theory or model of a single disease is the right one but we just need more data in order to understand it and I think this is the approach. This brilliant essay that I often rob refer back to written by Uras ethnic in cancer in two thousand and two as called Kepala. Just fix a radio. And he describes in hilarious detail, what it would look like if biologists took the current approach to understand disease and applied it to fixing old broken radio so For instance, this section wet several groups of researchers look inside the radio and they see that transistors, resistors and Pastas, different colors. So they spend their entire career seeing where the changing the color of a resistor affects the way that the radio performs which obviously complete nonsense but this is what I think. We're doing a lot of. With their fiddling with the color of resistors, and then wondering why we can't get the radio to work was colors do mean something. They do mean something but the internal workings don't change. So instead I kind of justify my my broad range of of interests because I think if you're looking at multiple mechanisms of brain injury across the lifespan, you're forced to look for commonalities and themes that give you an overall picture of the system and what the system requires both in health and disease rather than becoming hyper focused on a single mechanism. So I think even more of this to try and find meaningful ounces for those I with neurological disorders, and that's how I kind of tied together all those different periods of life in in different types of injuries to try and find some kind of some kind of commonalities makes sense to me. In the talks you give you often bring up maslow's hierarchy of needs as a way to sort of explain to people what a brain needs. Can you go into that just quickly for our listeners? Yes, I think that's a way that we can best connect or create a framework A brain might need in order to to sort of have long term long some. Health and there were multiple different ways you know theories to do that. But I I use maslow's hierarchy of knees because it was developed to give a you know an overview of the broad range of things. The humans might need for long longtime health sir, Abraham as low as an American professor of psychology and in Nineteen fifty-three published this paper called a theory of human. Motivation, which included this hierarchy of needs which must be will display pyramid. Now I at the bottom, you have physiological needs. So that's food water warmth rest and safety needs. Then you have psychological needs that's blowing this love self esteem and self fulfillment needs of the top, which is things like purpose and achievement and creativity, and it'll be able to debate as to whether. This is really you know the the final framework or whether these things change a time and that really matters because he just sort of gives us an idea to to put together things that might be important. So I've changed it from a pyramid from to a three legged stool for the brain of the things that the brain needs long term health. So those things. That's like and substrates and building blocks like oxygen and glucose security system protection from injury treatment for injury, and then protection against any kind of noxious exposures and then connection, and that's kind of broad, but it can be both between cells, but then also to the external world and having some kind of stimulation to bring all these things together. So as a stool, the idea is that each leg is potentially equally important, and if you're missing one leg, it's a lot harder. To maintain balance on just the other two legs. So I have no idea where this is the best model but I think it's a nice place to start to explain what is a brain needs for optimal long term health spent tastic and Tommy said that you find recent brain age studies to be particularly fascinating because they are just now beginning to show how fetal and neonatal exposures affect adult aging. So can you give us a summary on what these studies are showing us? Yes. This is a relatively new field because rony just now able to start looking at comprehensive data from neonates and how that's associated with outcomes in adults. For instance, the first premature infants who had significantly improved survival they were born in the seventies and then they were more improvements in care in the eighties and nineties with things like fatten and benefit elation. So these these people are only now in their fourth fifty. So only starting to see some of the some of. The signal that but in general people are born prematurely seemed to be an increased risk for almost every chronic western disease. So heart disease type two diabetes, obesity chronic kidney disease, and we don't really know about cognitive decline of dementia Nina exposures such as maternal infection, which could be at your tract infection or the flu while you're in you throw while while your mother's pregnant these are associated with an increased risk of a number of neuropsychiatric disorders like autism and depression. and. When You look at this in terms of aging, we have some data on people who are in Yusra during the Dutch famine during the German occupation in World War. Two. And those people seem to have older looking brains relative to people who are the same chronological age but weren't exposed to that while they were in the womb and there are some small studies show that people who are in their twenties and thirties now and they were born prematurely they show more rapid brain aging and shorter telomeres compels people who weren't born prematurely and and tell them on a great measure of aging but this sort of everything. Seems says look like it's going that direction that if you're born me if you have some of these exposures in the wound than you age more rapidly later in life, we don't know yet whether this is a permanent EPA genetic effect occurs very early on or whether it creates it increases too busy to later things like the environment or lifestyle that then may precipitate faster aging at the same time. If you expose these things in the women you're born prematurely, can we intervene early and then change whether this happens over time and that's something I hopes of myself and my colleagues will help to figure out. The Thomas step back for just a second and talk about what goes into growing a brain, and we know that when we were born brain takes up about seventy five percent of our metabolic rate. So maybe a good place to start is describing the energy needs of our brains wimmer especially in the developing brain. As species, we take a very significant risks to have the brains that we have an and I know you've had Stephen Canadian on the focused previously talked talked about some of this human brain is incredibly complex and very metabolic creek demanding. But at the same time when you bowl and your brain is essentially useless, you ought just like this complete anonymous lump that means that you have to rely on essentially everything from your from your parents whilst this brain develops and that takes a huge amount of time and energy in. The brain. We have to have a very significant energy fuel it which is why humans are essentially the only primate, the half fat babies. This is basically our buffer to make sure there's always energy available to supply the brain. While you know people often talk about glucose being an essential energy source for the brain in reality that stores that be turned into key tons, and then Keaton's also give a very significant proportion of of of the brain's metropolit- needs. Instead the last year he published a paper. About the potential use of exotic key towns for neonatal neuro protection, which starts at the idea of Keaton's being essential for the newborn brain you've been talking about can you talk about the rule of Keaton's and brain development specifically yet S-. So as I'm sure, most of the listeners know that the use of genyk diets exhausts sends a brain. Injury is a very promising active field of research that even you guys are actively involved in if you look at the unites of brain physiology, the developing brain. Will basically take up as many as you'll give it and by motor equivalents at least sixty percent more than than glucose and this relationship is pretty linear. So basically take as much as it can get. That's because in the fetus, and then also after birth and there are two mechanisms that ensure ongoing ketone production in the DNA so that the've your cells in the milk ducts, the mother's breast tissue they actively synthesize medium. Chain. triglycerides from glucose in the blood and those creased into the milk. So after being fed even though that comes with a significant amount of carbohydrate in the breast milk, they have MC tease those will be continuously being abetted in tetons alternatively between feedings or. Part of the reason why we have fat babies because breast milk doesn't necessarily appear immediately or there's GonNa be some time in between those fatty acids are going to be released from the adipose tissue and they're going to be ten key signs and newborn babies and two significant false ketosis essentially in a couple of hours. So in other words, newborns prime freaky tests. Yeah. Exactly. Which is why I'm very interested in key signs in Europe protective agent the baby's brain injury because if any brain is ready to take advantage of the neuro protective effects of keystones. DNA Brian make sense kitone bodies play a major role in the central nervous system during my nation not only sources of energy but also as sources of carbon for lipid bio synthesis, can you talk a little bit about the significance of this and try to tie this together for the listener when I was first looking at Keaton's Phoenix your protection this particular fights With something that was new to me, and actually probably the most fascinating thing that I found an even back in the seventies Hans Krebs who I can whose work. Let's quote as often as possible to can his group described the that Kitaen up taking the developing brain was at least on par with glucose like like I mentioned and they suggested that they provide. At, least fifty percent of the metabolic energy demands of the nie-nieto grain. This has since been revised down to about ten to thirty percent because some slightly later work showed that keystones preferentially used as synthetic Prekaz mainly for the reduction of saturated fats and cholesterol, and so if you want to grow a large brain, you need to make a lot of saturated fat. and. Cholesterol and keystones the main Prekaz for that. So if you think about anything that's not water in the brain about seventy percent of those fats and a significant proportion of that cholesterol more than ninety five percent of which has to be synthesized locally, and similarly about fifty percent of the facts there are saturated. Those also synthesize locally. So if you look at. Rats who are very similar to humans in this respect if you give them Keaton's those keys will preferentially be used as building blocks synthetic precursors to build the brain and then glucose will get used for metabolism. So you're thinking about keystones both in terms at Feldman, and in terms of brain injury is one of the potentially most important aspects. Because if you have an injured brain, you have to repair the area of damage and you're gonNA need new building blocks and everything that we see from the developing brain is the we preferentially use Keaton's to make those building blocks in them. We can use that to repair and Genera that that's the idea. In, addition to key tones, unsaturated fats also play a major role in brain development. Can you elaborate on this a little bit? So when again you're looking at the things that accumulate in the brain as you grow unsaturated fats are a crucial component, and so these are generally split into two subtypes polyunsaturated fatty acids. You might think of the mega threes, Mexico's, and then monounsaturated fats, and basically all the way during development, and then can continuing for years off to buff. There's an a linear increase in these unsaturated fats in the brain. So the most important ones being Dha should a long chain, fatty acid, a racket onic acid along chain of mega six, and then oleic acid, which is a monounsaturated fat and the timing is slightly staggered. So Dha is maybe more important towards the end of pregnancy and then. It becomes slightly more important after birth, but unlike the saturated fats and cholesterol, which is synthesized locally in the brain, most of these need to come from an external source. So they're gonNA come from from the mother from the Placenta during pregnancy or they're gonNA come from the Diet with smoke later on in general, these are GonNa come from animal foods although it is possible to synthesize some of these from short chain mega sixes in the mega mega three with Fahd's. Jeans. But this is a huge potential for diet to them. Play a role in terms of how available these all. So tell me what about what the mother eats. The maternal diet also plays an important role in infant development as Reno, and you've spent a lot of time studying the work of the late Sheila and s who was a tireless researcher and proponent of the nutritional needs of babies, children, and also expectant mothers. So what are your key takeaways from her research? Sheila in a pretty much single handedly pioneered the early research into polyunsaturated fats in the infant brain development including the effects of maternal and the composition of the breast milk. She was originally English. But spent most of her career at the University of British Columbia what I particularly enjoy about how work is the fact that she spanned everything from basic work and cell culture too small and large animal models and human clinical trials, and there's very few people have the skills and the interest to really translate all the way from the most basic research all the way to actually improving outcomes in humans and. Give a little respect for that, and she did a lot of work showing the maternal diet directly affects the fats in the breast milk. So particular when fast makeup significant proportion of the Diet then the composition of the breast milk in terms of fat content pretty closely follows what's in the Diet and about third comes from the recent diet. So what was maybe the day or the day before and two thirds come from adipose tissue, which again is usually stored fat you've previously eaten. So plays a huge role. There I'm one of the main takeaways from. Work for me is the critical importance of Dha. Again, this long chain mega three, fatty acid. She showed that it makes up about ten percent of the fats and infant brain and in insert neuronal sign ups is the right weather. The neurons are talking to each other and makes up almost a third of of of of the fight in the in the in the membrane, and then very importantly and something that's becoming I think increasingly important because of the the western Diet she did a lot of early work showing the dots she little Eric Acid, which is An Omega six I said can compete for Dha for uptake pretty much. Any Salva particularly into the developing brain something that I think we probably need to be more aware of, yeah. You mentioned little lake acid, which is a polyunsaturated Omega six acid. That is one of two essential fatty acids for humans. Since the early sixties, the amount of linoleic acid and Americans has increased dramatically is also increasingly women's breast. Milk is that a problem I think it is a problem and potentially large one that the average Americans consumes about six to fourteen percent of their calories from. Lynn. Lake acid and as a result like you said, the linear casted adipose tissue and in the breast milk has quadrupled roughly since the sixties and if you look at the amount that we're eating on average, you compare that to say the mass. Hunter gatherers have a relatively high fat diet. They get maybe up to two percent of their calories. And when we look at the available studies on Lynn, Lake has being essential. Some people say about two percent of calories necessary but it's probably as low as a no point, five percent and the confusing part of this is the phrase essential because it means something very specific nutrition. It means that ECON-, synthesize it yourself and you have to get it from food, but it doesn't necessarily need the mean that you need a significant amount of it for health. So for instance, if you want to study how essential a certain, a mega six fatty so I didn't let. You remove all the other mega six fats from the Diet, and then you add a little bit to see what can reverse symptoms is usually skin symptoms that you see either in rodents or humans the much like the other essential facet, which is Alpha Lynn. Lana cast is a shorter chain, a mega three, these two mainly actors precursors for the more important longer chain fat. So Alpha Becoming EPA DHA or has it becoming rocket on cassette? So I would argue the most of the function of little egg acid in the Diet as an essential component needs to be a precursor for longer chain record on a castle which we can synthesize. So even if linoleic acid is essential biochemical sense, we probably need even less if we can your racket on a cast which you would get if you. Have a small amount of animal foods in the Diet and even then we probably eating several times ten twenty times more than we would be guessing in traditional diets and over time has become a problem again like a sort of loo terrariums because it competes with Dha for uptake in pretty much every tissue the buddy and Dha is pretty much an essential component of O'Brien's and particularly on almost Andrea. Stem talk is an educational service of the Florida Institute for Human and machine cognition a not for profit research lab pioneering groundbreaking technologies aimed at leveraging and extending human cognition perception, look emotion, and resilience. In the lecture you gave that item see you talked about how many people may be suffering from a deluge of processed oils that have become really a staple in the modern diet and I find a lot of confusion on this. In fact, we've received an email questions about this for the ask me anything episode we did maybe I don't know three or four months ago. So when it comes to process oils, what do you see as the primary issue and what's your advice on this matter? Of really understand why people get confused about this and it always seems to come back to ldl cholesterol heart disease. We've been told for decades that replacing saturated fats with plant oils like canola, sunflower, soybean oil reduces ldl cholesterol, and therefore this reduced risk of heart disease. So why is true that these oils can reduce ldl cholesterol if you're play saturated fats with them and there is some epidemiological data suggesting that this is associated with reduced Odyssey's risk. The randomized control trials don't really agree with an either they showed no effects or potential for worse outcomes in those consuming. More of these oil. So the Sydney Diet Heart study is a good example where they replaced animal unsaturated fats with high linoleic acid, content, safflower oil, and Safflower Margerine, and that seems that she increased mortality and increase Odyssey's rights. So in the first instance, I, think there's been a conflation between proximal outcomes and long-term one but I would argue that it's probably mortality and disease risks that people care about more. But in reality, there's so much more to this scenario than just cholesterol and heart disease I do think one of the problems particularly when other people are maybe trying. To refute the claims that these vegetables bad for our health is the very loose terminology being used. So so people will say that plant oils are pro inflammatory been reality. That's not necessarily true. If you feed people soybean oil they, they're not gonNA have this big sort of increase in inflammation that you can measure. There's no like big increase in copd or these other things like you would get if you had an infection however when these fats accumulate and ourselves of a time, they can interfere with normal inflammatory processes because they compete with other fats for normal production of. Normal signaling molecules particularly, those they're anti inflammatory, and again that comes by competing with EPA and Dha the longer chain of a mega three, and again set a couple of times in Nina's O'Brien injury linley acid increases or competes with Dha for uptake into the brain, and then that increases the susceptibility, the brain to injury. So we've done that in in Nina's rat models, you feed them with the Dia-, highland, lake acid, the DHA in the brain decreases, which she also showed in pigs, and then if you into that brain, you get an increased injury similarly if you have A. Highland leg acid again, this in the lab rats and then you make route hypoglycemic or diabetic. The combination of the two is much worse than just either one alone. And this is sort of looking at a damage to the heart. So just in the short term, you probably can't see any negative effects but in the setting of any kind of inflammation injury, then it seems to to really worse than the outcome and I think this is important because the average person is consuming a lot of these and is also on the spectrum towards prediabetes Diabetes Metabolic Syndrome, which is incredibly Common. So I think this is really relevant over the lifetime, but it is really complex topic and some people have tried to boil it down to the mega sixty three ratio but that's also a bit of an over simplification because Salmon Mega sixes are essential health before we talked about that a record on cast it in the brain is incredibly important. So I understand why people are confused but I think that my Advice is fairly simple and it's just you cook your own food the the majority of these in terms of exposures come from restaurant and processed foods. That's where most of these oils go and you heard about during covid nineteen is few people go to restaurants. There's been a crisis in in soybean oil because the restaurants just not using it anymore because people don't use at home. So if you're at home. You can cook things in some olive oil avocado oil coconut oil these going to be better in terms of their content of these of these mega six fats. If you're a scout avoid fried things, particularly deep fried things and I don't think you need to worry about this a huge amount. You know if you have control over the majority of your food and is cooked at home than most of this problem disappears. So Tommy Dakota Heck Snook asset or DHA is a type of a mega three fat and since our bodies can only make a small amount of Dha to consume it directly from food or as a supplement, and there have been studies that have shown women who consumed six hundred, eight, hundred milligrams of Dha daily during pregnancy reduce their risk of early preterm birth. So that raises a question. So what about low Dha? An expectant mother does that raise her risk of having a preterm birth that does seem to be the case A. Particularly in women are high risk free birth, and that's the that's the setting that we see these trials being done. This process is regulated to a degree. So there have been some nice studies again, gather looking at the consumption and content of these fats in the mother, and then then how much gets transported over to the fetus, a rocket on, it seems to be always actively concentrated. So there's the level is always higher in the fetus in the mother bots Dha is more tightly regulated. So if your mother with a lower, Dha. A tribe has no a seafood intake. Then the the percents of works hard to try and increase relative DHA transport in into the fetus. BOTs. A coastal dwelling group and you eat more seafood than than actually you get less relative transport across Oh. So the placetas working really hard to make sure that the right amount of these fascinating getting over to the baby but I think there is a point where his where it's GonNa be it could be too low. There could be some some negative effects and again part of this is I believe is the premature birth is often associated with some kind of inflammatory process. So that could be either in the mother or in the Placenta. And Dha and some of the metabolize it Dha very important for resolving information. So if you're at risk and you don't have enough precursors all because you'll low and they're all being transported over to the fetus so gets enough Dha. Then that may contribute to ongoing found what you processes in the mother, which then precipitates appreciate both. And Reducing preterm birth is critically important because depending on how prematurely a child is born they have about thirty to fifty percent chance of dying or having a severe disability. So what recommendations do you have for expectant mothers in terms of reducing premature birth? In reality, this is quite a tricky question to answer because it's impossible to know whether you're going to have a preterm birth around ninety percent of births in the US Goto full-term, which technically is more than thirty six weeks but this does leave nearly ten percent being born pre Tom and the rate has been increasing recently from Sarah the mid nine percents to I think it was nine point nine, three percent loss chats and the mall. pre-term. You are the greater your risk of later death or disability the current events around twenty two weeks, which which is basically like fifty percent of the way through. But we particularly worry about extremely preterm infants which of those full twenty, eight weeks and they. Will have a fifty percent risk of death dispute as he later in life, there are a number of risk factors that potentially modifiable. So being overweight or obese or underweight smoking alcohol illicit drug use infections like I talked about. So this could be sexually transmitted infections, urinary tract infections and infections. So certainly, there's benefits treating infections when they come up will being up to date on your. Vaccinations if you need to be stress is a big factor which may or may not be modifiable depending on where it comes from. There are some other things that also very important that are going to be non-modifiable. So ethnicity is important, native American and African American women are more likely to have pre Simba's and does this very sort of new and fascinating area of research going into. Why that might be and there are some thoughts behind this continuing EPA genetic signature of the stress that these people have experienced as PA the histories in the US and that is possible changes. The inflammatory states isn't changes the increased risk of Kemba. Then age con change for being under eighteen or over thirty five increases, your risk socioeconomic status and lack of social support also play. A role with road again, be through stress or lack of access to healthcare says, it's really hard to say what somebody should try and change to reduce their risk of of course you know if if you have the ability to change those factors to make sure that your just as healthy as possible before you get pregnant or early in pregnancy than your risk will be much lower. So let's transition talking about preserving brain health at you're talking agency. You got your biggest laughed when you quote something that can once said, which is humans have roughly since the advent of agriculture become dumber weaker and more frail. So why is that well? I think the simple answer is that we've used our big and intelligent brains to engineer rule the difficulty out of our lives. I think it's almost ironic that the processes of evolution and the environmental stresses the official G is she built to expect has created. This fabulous brain is then able to remove those stresses such that it negatively impacts our health and cognition, and that's what I think we're seeing. So, if we are in D. becoming dumber weaker, what do you think we can do about that? So I think this brings us back to the things that you might say physiology expects you know the things that a brain needs to be healthy and a supportive environment is important. So die and sleep but I also think you you need to stop bringing in these stresses that we've been exposed to through our volition and now essentially gone. So frequent moving physical exertion called heat stress and significant. Stimulus. So most adults suggests on autopilot all day work at home, and you know if you think about sort of novel stimulated to the brain and the body, those really seemed to be lacking and that's where I think we can start to talk to intervene and bring those back in. Yes I agree I gave a talk recently, and in the question answer period I suggested that that it would be good to strive to become better animals than to recognize that we are animals and a small percentage of the audience was a gas. Hearing that they had anything whatsoever to do with animals. I think it's right along the lines of what what you've just discussed. Yeah. We just have to accept acknowledge who we are and where we came from it, and then try to build some of that back in. Indeed as you've pointed out in your lectures each of us is issued a single mach one brain the last Last a whole lifetime you know our modern lifestyle probably is in helping us much in this regard. So the question that I think many folks have is, how do we prevent the brain from declining over time prevent th-they declined and also even slow the decline if the declined turns out to be inevitable. I think some decline is always going to be inevitable I don't think we're a stage where we can significantly impact the maximum longevity of human by. Bernie make sure the brain functions as well as possible for the majority of that time, and this is where I bring up that legged stool again and I'm mostly agnostic to how people do it because there are many ways to approach the problem but again, I think in summary. You need the materials, good vascular supply to the brain. So you oversee needs to do all the things to keep. You'll and thalium happy and keep your blood vessels functioning properly, and then you know getting the right supplies nutrients building blocks from the Diet safety against things that can negatively affect brain hill. So sleep is incredibly important. Avoiding certain environments toxins like water quality may play a role at pollution. Sunny seems to be associated with with an increased risk of age related, cognitive decline and. Then, you know like we're talking about stimulus in connection. So regular cognitive workload is important. I, think we lose that particular to the end of our working lives and then into retirement and then social connections. So you know having strong social ties having friendships having those interactions. Humans are those are in credit, and if you maintain all those things and work harder to build them in than I, think is a huge amount of robustness in the system to to maintain function and health of the brain. Dave. asprey will be sad to hear that you think he won't live to one, hundred, sixty I really don't think he'll live to be one, hundred and sixty he might make ninety. Ninety would be just fine for most. Exactly, yeah, and if your brain keeps functioning so ninety I think that's a real good win. You've got that. So the amyloid Beta precursor protein is a membrane protein that normally plays in the central role in neural growth and repair, and later in life however, emily baited can become corrupted and destroy nerve cells, and this is what leads the loss of thought and memory and people with Alzheimer's disease. Can you give us an overview of emily precursor protein and as many functions in the brain? The. AMYLOID PRECURSOR PROTEIN AP is is quite fascinating because we know that it's incredibly important but but people might also say we don't know exactly all the things that it does, but it certainly involved in neuronal plasticity. So like the formation in connection, of Synopsis, between Ron's the transport of certain elements particularly on also the response to neurotrophic hormones and in dementia even though we see aggregates of beats amyloid, which is a cleavage product, a APP, less of the precursor protein seems. To be being produced. So that's that's part of the hull pathological processes that you know less of this is is being produced, but more of is being cleaved accusing potentially. So so having a normal system of production clearance of AP is incredibly important as well. ASSANGE downstream products, but this appears to get disrupted him cognitive decline but also has for some reason become like the one thing that we focus on when I think there's a lot of other stuff that's also gonna be important. Merck Pfizer Lilly and other pharmaceutical companies have spent billions as Carl Sagan says, billions and billions of dollars on drug trials aimed at targeting Beta amyloid. They've all failed essentially Why do you think that is I think that's because most Sims play beats. amyloid isn't a significant causal factor in Alzheimer's disease. Also, what we should more accurately call age related cognitive decline at age related dementia because we'll Alzheimer originally described is probably a case of early onset familial dementia with a mutation of something like the President Jean and beat amyloid is certainly associated in that process but that's not the same as the late onset diminishes that seem to be increasing disproportionately to. Increase in lifespan and which some people have said will cost a trillion dollars by twenty fifty and bankrupt Medicare. So I think we need to think about them separately and thinking about late onset cognitive decline. All Age relates Dementias, which is what most people are going to be concerned about. If you look at both road in human studies, the amounts of Bee's amyloid accumulates in the brain is not associated with either the rate of progression, all the amount of cognitive decline, and then if Utah get removal amyloid to say use a Monaco non-sporty, which many of these companies have tried, it doesn't improve outcome and even if you see less speech amyloid in the brain. Off You've given the drug, it hasn't improved cognitive function. So instead, age related dementia has all the hallmarks in my mind of neuronal metabolic dysfunction and I know that you had Francisco Gonzales a as a as guest previously, and he describes the vascular theory of outside disease where a chronic. Of. Blood flow results in down regulation of metabolic processes because of the lack of supply and then you get reduced production of things like sidestream smoke size complex four in the electron transport chain, and ultimately this results in methodology impoundment and Euronews dysfunction and death. And personally I think my view pretty much overlaps entirely with his. But if I use my three legged stool I, think that any one of those directions can potentially result in this problem and most of this is also supported by work that goes into Dr Gonzales says model. So you can elicit cognitive decline in rodents by juicing chronic reductions in vascular supply or you can do by poisoning the minds. Say with low levels of cyanide all you can do it by removing other rodents from the cage or removing what we call environmental enrichment. If you bring toxins if you remove necessarily materials or if you remove stimulation and connection, all of those can result in cognitive decline. So that's in my mind essentially any of the three legs of the stool that you can remove experimentally all you the each of those also happens in humans but other than some kind of side processes very little of it has to do with beats amyloid. Now, that no you and your wife Elizabeth wrote a recent paper where you argue that Beta amyloid as an epiphenomenon of neuronal stress. Can you talk about that paper and how you arrived? Yet this was a paper. The it was invited to review the general. AP L. Bioengineering, and eventually we sort of collaborated together on and it's cold. A disease directed engineering physiology driven treatment interventions in urological disorders, and if he thought the Tyson was long you should really take a look at the full manuscript because it's pretty epic but but we basically. Through the paper, go over all the main pathological processes associated with both acute and chronic neurological diseases and why we need a better understanding of the broader physiology and environment both inside and outside the body to create better therapies. I. Think. That's where we're missing some of the potential things that we can do and we use beats amyloid in Alzheimer's disease as an example of mistaking correlation causality, which I she happens quite frequently neuroscience and we we just presented the evidence. That I just talked about and what we do know the beats amyloid itself can be damaging. So maybe early onset Alzheimer's or if you have very large quantities and you can construct that genetically in mouse than it does seem to cause a feed with effective girono damage. But in most people, we talk about it being an EPA phenomenon because it's just it's just happening during these other neuronal stresses which are occurring which then a property whatever actually leading to decline. Well, let's now talk about the most common Ronald stressors. You've mentioned a few of them, but this is a good point to review them. These can range from inflammation to sleep deprivation and others. Can you give us a rundown of the list of stressors that you think people should pay attention to? The, the great question and I think that the big ticket items are going to be related to metabolic toxic stresses, injuries, and infections, and with all of these, we see evidence of abnormal protein accumulation in different ratios and different amounts in different places. But you know that includes bees amyloid. So these kinds of stresses you might think of hyperglycemia, insulin, resistance, heavy metals, or other toxins. So Ibm, Aa became this this talks in which you can get from sun algae that that people thought was going to be the root cause of outside disease and it just seems to be one process by which. That, this can happen and we might see something similar in traumatic brain injury or chronic traumatic encephalopathy. Repetitive concussions particularly associated say with with sports or in the military there have also been some studies suggesting that certain infections like herpes simplex viruses or pseudomonas ginger virus associated with amyloid aggregates. Although I will say that Herbie's simplex virus staters recently come under scrutiny, but it sort of just fits into the model. It doesn't have to explain all of of all of the dementia that we were seeing if you kinda fit together. So associated with these things, there is a parallel theory that suggests that amyloid is. Accumulated actively as a response to these insoles because it has oxygen metal collecting or antimicrobial properties, we talked about is very important Farai miles of important because it can try and target this insult, the this come up which which may be infectious or something else. So a such a don't think this huge about evidence to support this theory about it would make sense of this, some kind of response to a noxious stimulus and all of these things seem to result in some accumulation of amyloid visas. So anything's possibility and as you try and let bill this big picture of causes of of age related. Dimensions I think it seems very likely that this broad range of things can cause issues and the amyloid visas essentially just being produced kind of side product and they may get to a point where you have so much that it becomes problematic on its own, but it certainly doesn't seem to be important if you're trying to to intervene or prevent these things happening early on in the process, this is probably a good time to talk about the microbial which are known as immune system of the brain. Can you give us a little rundown on their importance and explaining exactly what they do in their general sense? Thing. Is Worth me starting by saying I'm far from an expert on market glare because there since you their own complete weld of complexity and research that just gets deeper and more complex almost by the day. So as a neuroscientists, my training is led me to be a neuron centric. So so I may just rely on the mike clear dummies definition, but they're essentially the the resident immune cells of the brain like you said, and they come from a similar lineage to macrophages elsewhere in the body that people may have had of the very important in the response to infection or other injury, but they also have sort of A. Static prices like they're involved in in pruning sign ups is in your strengthening and weakening your connections as we as we learn new things will change you know other external factors and Michael Lia are increasingly being targeted often neurological injury because they can have both pro inflammatory and anti inflammatory phenotype. Soon, there the several that fit into those categories, but seems to be some evidence that. Pro Inflammatory Michael. Not Adequately switched off or you know switched phenotype back to a more resting or anti inflammatory phenotype. They can then contribute to ongoing injury. So that's why Michael here becoming sort of a big arena and Europe protection field as as people try to figure out how involved and then maybe whether we can talk therapy. So, Tommy I'd like to back up a little bit and talk about how inflammation is associated with almost all neurological disorders. Can you talk about that and also the role of fatty acids and inflammatory signaling in the brain? So pretty much every chronic disease. You know not just those in the brain that seems to be this element of chronic inflammation and when you're thinking about how these prices thought, and then how their resolved this is where facets become very important and you know a normal inflammatory process you know in response to something is should absolutely happen. We often think about inflammation being a bad thing. But in reality, it's not you just need to be able to switch it off when the you've done the healing switching off his part of the healing process and if you think about. Signals in the immune system as of this sort of inflammatory signaling to be very broad group save your cytokines. which are proteins, and then you have your lipid mediators, things like Prostaglandins, leukotrienes, and these The latter are produced from the mega six, three fatty acids that we were talking about earlier. So the initial immune response is logically coordinated by some prosecutions leukotrienes created from rocket on a cast, long chain mega six, and that's part of coordinating the response but eventually, you need to switch over to a class which we might call it Michael also somehow dampen down the inflammation as we resolve it, and this requires lipid mediators from the mega three fatty acids, EPA Dha. And a lot of this has gotten attention recently from the work of Charles Sahan and specialized pro resolving mediators. SPM's they call them in I. Know You had David May on the poku previously talking about this and when your in the process of trying to resolve this inflammation. Then again, EPA DHA becoming poor precursors full these resolve INS or protections marines, which which were involved in in kind of you know the the the final resolution and healing process going back briefly to. Little acid. What's interesting is that it competes with the same enzymes that used to create these mediators and instead create something called oxidized Linda Lancaster metabolite. So Oxfam's and these seem to be increased in a certain disorders such as Alzheimer's disease and they as well as competing for the those the same enzymes they can stimulate this initiation of chronic inflammation rather than letting the body heal and resolve the information by using some of those are the mediators, defoe a threes. So timing I suspect some listeners are wondering what's the difference between acute inflammation, chronic inflammation and chronic inflammation determine that's thrown around a lot these days. So can you explain the difference between the two? Yeah absolutely it it can be difficult to kind of conceptualize chronic inflammation because it's not necessarily something that you can actively see when people think about acute inflammation you're thinking about the cardinal signs of inflammation which learned in medical school, which ruble Callo Dodo and Chuma, which is flattened for redness swelling pain and heat. So those are the things you might see. If you sprain your ankle, all breaking arm or something that's the acute inflammatory process, chronic inflammation. It's usually happening like deepen a tissue somewhere and can go on for months and years, and you might be able to measure something in the blood like you know, maybe people have heard of a p level or something of that, and that sort of a lowest level might indicate some kind of chronic ongoing flosse process. But in reality, it seems to be driven at the tissue level like the immune system in that tissue, not resolving and continuously sort of propagating. It is that's going on, but sometimes it's very hard to spot, and then that's just because it's the sort of this very low sort of indolent issue in the brain is almost impossible to easily measure a. then you'll see the same thing in the fat tissue if you're a beast or in in other tissues in sort of heart disease and types of diabetes. So these things a very, very common, but it's not this very obvious thing competitive what you might see an Aq-. Information. One you lab has been looking into is how modulating micro glee can reduce oxidative stress. Can you tell us about that research and I just have to say my probably my favorite cells so I'm looking forward to this answer. Well. So so again, I'll I'll repeat I'm not an expert and probably leave that to to people like you and Elizabeth and. I essentially kind of fell into this area and largely because of collaboration with Elizabeth and some other colleagues including one who has significant. Expertise Gwen Garden who you know that UNC Chapel Hill Dawn. And in some of the work that we've been doing, we've been looking mainly at the drug as my sin in the. Antibiotic. Career people have heard of his e pack and it's very interesting because it causes a fingertip switch likely it seems to turn them for these pro inflammatory Markley back to these more anti inflammatory market here, and in the lab we have again in collaboration with with Elizabeth, we have developed a slice culture model. So we take brain slices from from the Ferret and those include all the different structures of the brain and we. Can then do a model of stroke in in cell culture, but allows us to much more easily look at things like career, and so if you do this injury model, Goule Oxygen Glucose deprivation, which is essentially like removing the materials that that that you need for health and this is something similar to a stroke. In this kind of cell culture medium you see increased injury like like he would if if you had a stroke or. something similar like the Nina branches you talk about. The Michael Potter is they become activated and if you put. It into the medium you then see less mockery lactation and reduced oxidative stress, and similarly, you can give to mice into neonatal rats off to a neonatal stroke type injury, and they seem to have a reduced by of injury and both like the brain we have they have less loss of of brain tissue and they have improved neuro behavioral outcomes they a functionally much more intact than they would be if they weren't treated with it, and so we're now trying to translate as. To Law models, particularly the Ferret. So again, looking at both priests brain injury and term brain injury where both of these things will be relevant and. Is. Probably one of the more promising therapies that we might use India NATO brain injury We think a lot of it happens through its actions on my clear but we also know that it's it's safe in pregnancy and Indiana already FDA approved. So that kind of makes it closer to being a translated to humans. The problem however is the micro Leah Have Long Memories. So that raises the question of how you reduce micro Galil activation. This is a fascinating area I and I think that some of it might underpin those things that we talked about earlier in terms of infants being born prematurely or exposed inflammation in the womb, and maybe some EPA genetic effects that are happening and a low of that might be creating memory, and my quickly then results in them being either more sensible won't more pro inflammatory throughout the rest of life something similar might be happening in macrophages elsewhere in the body, and for instance, if you look at Ala Premature Brain Mullin. The. Ferret. And then take those brains several weeks later. So the equivalent of say a child of a few years old then then you take the mic clear out of those brains and you look at what genes expressing, they look very different from control clear. So they're expressing more genes associated with inflammation and fewer genes associated with more of an anti inflammatory phenotype. So there's a lot that we can dig into that but the those market definitely look different and again, this is several weeks and years developmentally further down the line. There was a fascinating study looking at. Margaret. Activated in the brains of people, months or years after its romantic brain injury, they used a single photon emission computed tomography or scan and a tricycle. Nine five, which basically has a high affinity for activated or pro inflammatory multiplayer, and in those patients, they saw increased Leo activation in the Alamo, which is basically the relay station for sensory and motor information to the CORTEX and this activation persisted for up to sixteen years after the injury and the degree of activation was associated with cognitive processing speed in those people. So this suggests the even several years after injury he still have this ongoing chronic inflammation in certain areas of the brain, and that is actively affecting cognition, and so this this is again, polly makes a very interesting potential target as for what we can do about that. Like I said, this is probably a question for. Elizabethan and dawn as we develop better techniques to deliver therapies to the brain. But I do think that reducing the number of other detrimental things we expose our brains to will be beneficial. So making sure we have the raw materials to create a pro inflammatory response we talked about the fatty acids maintaining insulin sensitivity, super important I think those things will help. But we certainly also have a lot more to learn. To Tommy just searching the subject a little bit but still thinking about oxidative stress and McClellan. We, recently interviewed Francisco Gonzalez Liam. As you mentioned earlier about his research methylene blue as a narrow protecting this episode. One is seven on stem talk and since that interview you and I have been discussing the possibility of looking at methylene blue to protect against hypoxia induced cognitive decline and individuals working altitude is a big area of research here at agency and I know that we're both excited about this upcoming study. So what are your thoughts? Not? We've been digging into this a little bit on the potential. Meddling blue in the setting of acute brain stress or injury, not just hypoxia but just in general yeah I think that methylene blue is is an incredibly interesting potential intervention and both acutely and people want to try and maintain cognitive function in high poxy but also maybe after keep brain injuries as well and there are some people who Stein set to look at that same method blue is a synthetic dye. But at low doses, it's essentially an auto accident so it can provide a free supply of electrons. into the country activity accumulates in areas of the brain the mathematically. So essentially going to go to where you want it to go and. It's GonNa continue to provide electrons even in the face of maybe some kind of decrease in material. So so if you think about oxygen during hypoc Zia blood flow to the brain tends to increase but glucose uptake in the use of oxygen. Relatively, I'm can decrease in this can be mitigated by giving small doses of methylene blue and and most of that's been done in rodent studies. But A, you can basically increase the efficiency of extraction of Auction and you can increase glucose uptake. You can maintain metabolic rate under hypoxia if you have methylene blue onboard and then if you if you look a acute human studies, you give methylene blue and look at the functional MRI is. An hour or so later you see increased connectivity in in the active areas of the brain and improved short term memory performance, and the the idea would then be the in those people who are going to be exposed to high pokes here you can give methylene blue and that's going to help them maintain function activity in a crucial areas of the brain that they need for decision making or whatever it is that going to do. So I think it's you know there's there's a lot of potential there, and if you get the dose and timing right I think is an exciting way to potentially ensure people maintain cognitive function with they're when they're under stresses like I. I. Agree I have to say as you're talking Ken, stuck his tongue out, which is coated in blue. He's actively testing. So I'm often and. That is true. And so many ways. So it's increasingly widely appreciated that maintaining insulin sensitivity is critically important as we go through life but here in the united. States and really and. It's it's not just that I'd states if you WanNa see a good example of this visit the Middle East like the UAE, for example, in most of the world rarely we're not doing a good job of maintaining insulin sensitivity. I've seen it reported that about eighty percent of Americans have some kind of metabolic disease. Can you help our listeners stand why this is such a major health issue and why we should be concerned about it. It's. A major health issue because those processes are associated with pretty much every chronic western disease that they might be the listeners might be trying to prevent or stave offer as long as possible including cognitive decline and the the numbers that you quote come I believe come from a fairly recent paper by Araujo Atoll cooled prevalence of Ottawa metabolic health in American adults, and they looked at seven years of Hans as about nine thousand people and using some of the premises of Metabolic Syndrome. So waist circumference, blood pressure, blood, glucose, triglycerides, Inacio cholesterol they tried to see who had optimal levels of those things and they estimated that eighty seven point eight percent did not or had sub optimal metabolic health. And she argue that it's it's going to be less than that. Always going to be more than that with more health because they're cuss also blood glucose and Chagas rights were one hundred and one hundred and fifty milligrams per decilitre respectively, which if you're looking at sort of later health outcomes, you probably say optimal is closer to less than ninety glucose in less than a hundred photographer is. So what you're left with is that basically a very tiny proportion of American adults are in good metabolic health, I mean no. From elsewhere, that's more than forty percent of US adults have at least one chronic health condition and more than fifty percent have some kind of long-term prescription medication assume reality the average American again, don't want to just bag on. America. It's definitely in seed in multiple other countries lived. These sort of West is lifestyles on average where we're sick and that includes some communist bollock disease or instances, and what comes with that will things like heart disease and dementia, which which people are trying to to avoid. Yeah I always hate that term Westernized. It's sort of a like healthy whole grains. It's It's like built into the discussion but his vacuous. So if you go to India, for example, you really not westernized but they have these problems in spades or Italy, which is the cradle of Western civilization they're doing much better I they're eating the Mediterranean. kind of this is the whole other point. Back. You was term. Up Equally, you're also the I guess the reason why? It's so easy uses because as soon as I say westernized and you know then you know what I mean even if it the the west, an aspect You mean back. Modern. Modern. skin-tight. Stem. Stepped up. So I have to say I see what Tommy's white Elizabeth means when she says the Tommy's always researching the scope of his interest and expertise. It's just absolutely amazing. How many people do we know that work with newborns with neonatal brain injuries as well as Formula One race car drivers that's pretty widespread, avid St Thomas the only person that I know just one of those who'd be enough to be the only person you know. Yes Yes, Don the range of Tommy's research is indeed impressive and I was particularly interested in what he had to say about the physiological and metabolic responses to brain injury in their long term effects on brain health. If you haven't listened to our two part interview with Dr Franciscans Ali's Lima which also dealt with brain energy and brain health in particularly brain energy metabolism. I. Think you'd find it very interesting. Highly recommend looking up episodes one. Oh, five and one. Oh, six listening to Francisco in Tommy back to back. We'll give you a great perspective on. Three or four fascinating aspects of brain health definitely agree can, and if you enjoy this interview as much as I did we invite you to visit the some talk web page where you can find the show notes for this and other episodes at stem talk dot us. This is renee signing off for now and this is Ken, Ford, saying goodbye until we meet again on stem talk. Thank you for listening to stem talk? We want this podcast to be discovered by others. So please take a minute to go to items to rate the podcast and perhaps even writer review. More information about this and other episodes can be found at our website stem talk dot us there. You can also find more information about the guests we interview.

Dr. Tommy University of Washington EPA US Dr Ken Ford Dha Keaton metabolic disease Tommy Dakota Don flu research assistant professor Thomas Coach football Elizabeth Nance Google Carnegie Salva Israel Nina
Carl Zimmer and Paul Offit on Genetics, Race, and Vaccinations at CSICon 2018

Point of Inquiry

33:25 min | 1 year ago

Carl Zimmer and Paul Offit on Genetics, Race, and Vaccinations at CSICon 2018

"So people somehow try to find these constellation of characteristics that they can somehow use to define being white in that somehow that is intrinsically biologically special. But it just doesn't work. Hi, everyone. It's me your point of inquiry co-host covens, we're back this week with a couple more interviews that I recorded during last Saipan in Las Vegas, I up checkout. My interview with award winning science writer and New York Times columnist Carl simmer, his talk at sei con was on the powers perversions and potential of heredity, which is also the subtitle to his latest book, she has her mother's laugh after my conversation with Zimmer will hear from Paul off it he'd be attrition inventor of Rotavirus vaccine at tireless advocate for science based medicine, especially when it comes to accedes. Hello everyone. I'm still here. Live from stike con in Las Vegas, and I get to speak to Carl Zimmer today. Thanks for being here. Carl. So Carl gave a talk today about his book and about heredity and misconceptions about this concept, but you raised an interesting point in years past of course, we know that by CS have influenced how scientists carry out research. So when it comes to today's research on Herat be what are the by season mythological issues that you've encountered in covering this in which ones are perhaps the most egregious will. I think that there are. Bias sees in the way that scientists sometimes think about the research in there also just biases that emerge in the data itself. So in terms of heredity and studies on genetics there if you look at the data of who has been studied what populations? Do we understand genetics in connection genetics health? Well is the European population? It's wiping its people in Europe or people the United States of European descent and hardly that is because that has been where a lot of the research began there has been neglected other populations as a result, and you cannot just generalize out from what you learn about the way Jean's work in a your. Opean population to other populations. So just to get one example. By studying European populations. Actually, scientists learned a lot about height height is controlled by many many genes and scientists are denting those jeans, and they can actually like look at the versions of those genes that people have and do pretty good job of predicting their height, you know, within say within a couple inches, which is pretty good in the road genetics. But that's only when they're predicting on people who are European if you look at those same jeans in a group of people from Africa, you do a terrible job. I ended there are tall. People in short people in parts of Africa just tall short people in parts of Europe. But you can become tall by different paths. And I and so by they don't believe they're part of a gene the, gene. There's just a huge amount of genetic diversity in our species. And we right now, we're not we're really been focused on just a fraction of right reminds me of myself actually for my listeners since I'm new to point of inquiry. I am trying to lose about twenty more pounds because I'm pre diabetic, and we have diabetes all through my family in people who are mostly thin, and otherwise very fit, and it turns out that the rate of diabetes and prediabetes in young people in the population is just way higher and the risk factors differ quite a lot on when compared to white people. So I'm interested to seeing to see the research that comes out of India, perhaps reference, genomes, etc. I guess that impacts so many different health issues. Right. Really? Yeah. I mean, and within the United States, you have people from lots of different backgrounds, and so if you're trying to use genetic data that came back from just mostly from one background is going to be a problem when you're trying to do public health across country. But you know, there are people know this this this is not something that people trying to deny the there's a nurse shot. You know, like it takes a lot of effort to start up a whole new research program. As opposed to just building on research program. That's right running. So there are some special initiatives. Now, you know there is a precision medicine initiative from the national institutes of health called all of us and olive festival uh Salma. It's so tired olive fest as otherwise that's all of us. Yeah. Yeah. So so tha majorly the goal is to bring precision medicine to country as a whole public health, I and they fully recognized that they have to reach out to lots of different communities to to get better profile of the genetic -versity of the United States. Even if that means, you know, recognizing that some communities look at this kind of research with a lot of skepticism in hesitance because it hasn't gone well for them interacting with these sorts of scientists in the past. So it's definitely a worker progress for work in progress. But it's good to at least see that initiated. You. You mentioned a lot of misconceptions about heredity any covered a few of them today. What would you think are maybe the top three and most navy stubborn misconception? At least when it comes to just public the American public. I think one big. Misconception is that if your descended from someone special that makes you special, you know, there are there's actually something Charlemagne society actually on which is only open to people who are descended from charming. And you actually have to prove that you're descended concerned people who are known to descend from Johnny to get in. But the fact is pretty much everyone in Europe today is descended from Charlemagne yet is some people can improvement in have the for some reason. Drive to join the society. Yeah. But you know, the implication there is it's part of some, you know, super special group that that's so they really do consider themselves special is what you're saying. I'm not very familiar with them. I wasn't either. I started doing research book. But there they weren't. And I just think that that kind of like. It shows just how much we cherish these these famous people in our past. I mean, I think we all come across someone who claims to have someone famous William the conqueror and so on, but the fact is that genealogy actually doesn't work that way. Like, actually like, you the further you go back, the chant the more more the chances go up that there's gonna be a common ancestor that a lot of people share so mathematicians of actually solve this basically a graph problem. And so in a continent like Europe, if you go back to the time of Charlemagne, if you find someone who has any living descendants, they probably are the ancestor of all the European made his one, and if you go back a few thousand years for further you're gonna find a common ancestor of everyone alive today. So you don't have to go back very far to find a common ancestor. Obviously, we if you go back years, we all have like millions of ancestors. But the fact that you can track yourself back to somebody famous. Really that's not how genealogy works, and you did not inherit that specialness. Yes. You have to have your own special. Exactly, exactly. And so. Yeah. I mean, we specialness is not. Heritage in that way. Yeah. It's better. If you try to do it on your own. So I think you covered this today at I have yet to read what he wrote. But today, the American society of human genetics denounced attempts to use genetics to bolster the idea our notion of white supremacy or racial supremacy, and they write in a statement that they're alarm to see a societal resurgence of groups rejecting the value of genetic diversity and using discredited or distorted genetic concepts to bolster bogus claims with white supremacy. So I've noticed this resurgence is well, what's your observation on this trend, and what do you think is driving it right now? Well, I think that maybe there is a feeling that among some people that they define themselves as being part of this population that that they think is. How better than other populations? And you know, as in the United States says as we have more more people who are Spanish black who people who are not white than that that makes some people feel threatened. And so I think that they then look around for some kind of justification for why they're special in other people are not. And you know, there are just some people who are just. Just you know, are flat out racist and always have been now, they're like a Neo Nazi they now look to these genetic tests hoping to find, you know, quote, unquote, scientific validation that they are superior the stuff that they come up with is is both just as the geneticists say one example is, you know, there is some white supremacists. To like to make a big deal that they can drink milk because you know, northern Europeans have a high levels of lactose tolerance that just means that they descend from cattle hurting societies where natural selection favored a mutation that allowed people to make the enzyme for lactose when results that's it. That is all there's no like, oh, and also that makes you super special and allows you to be there. Reasoning behind this. Then what's where are they getting that their ability to tolerate lactose makes them superior or how do they spin it? It's really hard to find any sort of coherent statement of reasoning about it. Instead, you just see the men, you know, drinking milk in demonstrations. Like as if that's as a gesture I should like that political almost masculine. Yeah. I I don't know. Maybe you could say that. While we shit. I'm curious now, I'm going to look up videos. It must be on YouTube Bryce, today's white supremacist. Yeah milk. I remind premises drinking milk. I learn something new every day. But here's the thing. Here's the thing is that. They might try to claim that we'll lactose. Tolerance is part of like this this great suite of traits that make northern Europeans great or something. I don't know. But it's just like this one result of evolution in humans. But it's the same. It has happened in parallel in other places. 'cause like northern Europe is not the only place where people have raised cows. So if you go to east Africa Vigo, and and look at Masai and other people there Africans dark-skinned avenues, they are also lactose. Tolerant. It's an unusual trait. It is an unusual trait. But it's not some sort of white special trait. So people somehow try to find these constellation of characteristics that they can somehow use to define being white in that somehow that is intrinsically biologically special. But it just doesn't work, you know, even with skin color. I mean, we're very sensitive skin color. I think just because we're a very visual species. But to to try to use skin color as a way of dividing up races. Classifying races is always doomed to failure. And the fact is that like even in Europe. It turns out ancient DNA shows that people in Europe weren't actually light skinned until maybe overall until maybe four thousand years ago. So they've been people, you know, our our own species in Europe about forty forty five thousand years, at least they were quite dark skinned. Yeah. Yeah. I think this is it's not quite it's almost as ridiculous to me. As flat Arthur's, but not recognizable as ridiculous to your typical person. In most people who aren't fatter Thor's are flat Arthur's, those people are nuts, but white supremacy and now these kinds of justification are so mainstream which is what makes it particularly disturbing. Yeah. And it's and it is I mean, it's their hostility extends in many directions. So, you know, my father Jewish and so like, I whenever I'm writing about this sort of stuff on for the New York Times like on Twitter sooner or later. I see somebody referring to me with all those parentheses marks all far there's a Jew talking about this stuff. So we know what that means is just very ugly fact of life right now. And I'm sorry sorry that that made it shouldn't have anyone. But it happens, of course, all of us in its sake can be ugly place. I look I mean, I am. I am not pretend. Ending that I have to deal with a fraction of what other people do this regard. It's just that I think of myself, and very privileged wipers. But I get it while it's if it's good that you recognize that because a lot of people don't so your book, she has her mother's laugh. Tell me about the title, and what the impetus behind this is what you hope readers gather from it. So I think ever since I became a father some teen years ago have two kids I have been really fascinated by Haredi simply because I've been watching these two people grow up, and I know that they're descended from me. And my wife, I look at them in wonder like, well, how did they become becoming? It's fascinating. My kids are seven and five just their behaviors there. So you can pinpoint who they seem to come from him. Sure. Some of this is just invented in our mind, but some of it is uncanny. Any there? I'm sure there's a lot of pattern matching. And and it is funny that like people will say, oh, she got that from you. Oh, she got that from you. Or didn't get that. From me. No way or only member how great grandma Mary had did that. Sometimes she must have guy from great-grandma on there and things like that. So somehow just saying like, oh, she has her mother's laugh to meet kind of captures that that ambiguity of of trying to figure out heredity in wondering, you know. He's this something that's encoded in DNA that you inherited. Or is it something that you inherit through the experience of growing up in household someone? I was just say nobody has done study haired ability of laughter. I can't tell you. If there's, you know laughter flashing your has. Okay. I don't know. But more like a metaphor to get at what I was trying to explore in the book, which is this. How does it heredity has such a power over us in? What is ready action? While check it out. She has her mother's laugh by Carl Zimmer thanks for being here with me today. Thanks so much. There's just so much to consider when it comes to heredity, isn't there? It was just thinking I mentioned before that. I'm a parent of young heads. We spent so much time trying to work with Oren guest heredity, depending on what's going on. But we've been doing that since well before we ever sequenced or even knew about the human genome moving on. Let's dive into my interview with Paul off. It he presented at side this year on communicating back seen science and ventures and miss adventures with the media. Hello everyone. I'm here. Again, live from Las Vegas at side Kahn, which of course, is totally. You know, we come to every year, and we have a great time. And there's no better time than talking to some of these speakers at SICOM. I'm here right now with Dr Paul off it who is a higher less communicator and defender of science and all things back seen. He's called inventor of road of virus vaccine and a hero to the skeptic community. You could say so welcome thanks for being here. So today. Paul talked a little bit about some of his mistakes when it comes to communicating science. And I think that we as a community can learn from that. So can you tell us about a couple of your mistakes? You will have some of the obvious ones that you don't have to answer the question exactly as ask. So once I was asked the question on a local show. So Dr Patel, how many vaccines children get when do they get them in which ones they get. I mean, if you actually answer that question, I think you'll set healthcare communication back about twenty years. I mean, you need a broader answer like children get axes to prevent have Titus and meningitis bloodstream infections among others. Children should make sure they get the vaccines. They need to be safe not to actually answer the records. But it took me a while to figure that out. That's one example. So how would you answer that question today? That's all it answer. The answer by saying children, get vaccines to prevent diseases like, and then just mentioned the disease and not all of that. You get more vaccines. All the Bax this age this age, you got hit back soon decisions Kanter the pretty much conjures that that image of the baby with all of their needle stuck in their leg. That's the other mistake. I made actually all this question. How many how many vaccines coulda child get instead of answering? It the way I should've which has said, the children's responses are broad and deep they can respond to many more vaccines getting I actually answered it the way you knowledge us when answer it was trying to figure out, you know, the sort of nets of antibody diversity, how many how many antibodies can you make you know, give yourselves make antibodies how many b cells having about and I came up with a very conservative figure ten thousand. But when I answered it that way, when I said, it trial could get as many as ten thousand bucks. I became the ten thousand vaccines. I mean here the people challenge me to get down XI's. There was a PR news wire that came up that said I received ten thousand vaccines died. I mean, also like the PR people in my. Ospital call to make sure I was still alive. I mean, it's Molly. That reminds me of the similar mistake. You were just talking to Dr Karl von mobile the plant geneticist. But there was a similar mistake. I think made by a few scientists when it came to drink pesticide and like I would drink that. And then they became the people who would drink toxic pesticides. So just yeah. Let's let's not drink pesticides. Even though maybe they wouldn't hurt. You. What are some mistakes that you see because I know you're pretty active on the internet. So when it comes to, you know, someone being wrong on the internet about vaccines. And of course, there are are many in the pro vaccine and skeptics community that are quick to jump in. And do I mean what I think is the noble work of of correcting misrepresentations about vaccines and other issues. But I do see some mistakes. And I was wondering what you see the most. When it comes to vaccine vaccines in particular biggest mistake to think, we don't need to explain our selves. The thank you know, when my parents were children in the twenties thirties they saw diphtheria killer teenagers. They saw polio. Crippled of young people. They understood the imports. I was a child of the fifties sixties. I have I had mumps I bel- I have I had all those neck convince me vaccinate nitro, but my children are in their twenties. I mean, they don't see these these today they didn't grow up with these over that vaccinations matter faith, faith, and Hoon pharmaceutical industry, medical stabs -ment in the government. There's lack at least in that kind of fade. So I think we need to step back and say, here's why it's still important to get these vaccines because prepared standpoint, you know, we as parents of young children to to give their their their children about fourteen vaccines court different disease. I can be as. As twenty six occupation during that time, you can meet as many as five at one time disease. Most people don't see using biological fluids. Most people don't understand and people look at this. I need a polio vaccine. Why depicts the polio their own black and white? I need theory of accede attendance next what he talking about. So I think it's hard to watch your child get five shots at once. No matter decay, you are in knowledge or science Veraldi. So I think we do need to vigorously explain. So we'd all to them. What's gonna happen is what's happening, which is that you'll see some of these these are coming back. I mean, we eliminated this company in the year two thousand gone, but it came back because we chose not to the accident children. We eliminated rebel which is a dangerous faction. If you get rebellious or measles in the first trimester pregnancy, you have an eighty five percent chance of delivering a child with birth defects, permanent birth defects. Do I think would rebel which we eliminate it from this country could come back? Absolutely for the same reason that measles come back. And then. And maybe that's what it takes. Maybe the only way people are going to really get vaccinated again is they're scared of the diseases that happen really in southern California. Which was a hotbed of antibac- seen activity two thousand fourteen two thousand fifteen there was a measles outbreak. That started in the Disneyland area spread states one hundred eighty nine people, and then suddenly mothers and fathers, southern California. We're getting their vaccinate. Because the vaccination rate call up like noticeably because measles now is knocking at their door or the next door neighbor. And now they were scared. But it's always the children have to suffer ignorance of stuff. Yeah. Yeah. And that's that's unfortunate thing I only had to go through chickenpox. So I consider myself lucky, I'm thirty six, but I guess my kids are luckier than I am because they don't have to get chicken pox before. I had kids I guess up oblivious to a lot of this. I didn't even know there was an anti vaccine movement. And I'm reading all of this information coming at me. And I'm like, wait. I'm supposed to be worried about vaccines. One of my supposed to believe, I don't know. So then I I guess fortunate enough and had some somehow found the skeptics community. I think I was already may be prime to find which was great. And then I learned I learned all about it. And I'm like, oh, yeah vaccines. Great. Good wonderful. Let's do it. But I mean, I think at least in my observation there are a lot of people like that. Not really thinking about these issues until they have kids. So what do you think differentiate someone stay like me, and I should add. I'm I was a huge doctrines fan until I had kids too. So I was the kind of person that was saying, Dr Oz recommended supplements. So I'm still trying to figure out why I went in in the direction of skepticism. So what do you think it is that maybe? Might cause a person than to have a child and not really know about this and fall into the other rabbit hole in decide to either not vaccinate their kids or though some vaccines. It's hard to what your get five shots at once. That's it. That's what you said before. And that's the one little two month old. You're lying. I will be back seen giving us it within twenty four hours birth. And that just doesn't seem fair two months of getting five shots. Once just like, they don't even have enough limbs, it seems to get all that. And so it's that it's motion. And I think for those who has attained its understand why I want to say it. It's not hard to find information on the internet will make you feel better about not vaccinating a group of people who also don't vaccinate you cannot vaccinate to. Here's all the reasons why because backseats calls all these things that they don't actually cause. But at least, you know, it makes you feel like you're not not making a bad trade because right now, it's what you're doing is. You're protecting yourself against infectious disease that could kill you. But if the anti vaccine people argument, essentially is that, you know, I'll risk the infections, which I don't think are that common to prevent these chronic disease. The can be lifelong awful. So so that they think is the trade even though that's not the trick. Right. Yeah. So I guess basically. What you're saying is if you're already feeling like this is very emotional harm than you have confirmation bias than you go to that information on the internet. It's just it's endlessly frustrating. How do you deal with the frustration of of fighting against us? I mean, doesn't it seem like an uphill battle. Sometimes. The I haven't my mind our children who come into our house blew suffering, doc vaccine Venezia's, I mean, they've got it because their parents invariably got bad information, which calls them to make a bad decision which put their child at risk and occasionally death watch that for few times, and you become a vigorous passionate advocate for this. Because that's always your your mind. Would you do is you try to understand mode? Most parents say eighty five percent of the parents who call me really wanna know what's going on. They smell the smoke. They want to know whether it's any fire there reassure bowl. I may really would prefer to trust their doctor because when you go to your documents. I don't want these vaccines, you're saying, I don't trust you. And if I you know, I don't trust for vaccines. There's other things I may not trust you for to you want your doctor to like you because you when you're sick, you want your document care. And when you say yourself apart of your doctor, that's hard thing. So I think most people really do want the facts. And are influenced by the facts may say eighty five percent of the people can be influenced to get back seat. Because once they have the facts they see what the right decisions but fifteen percent or conspiracy theories they think there's a conspiracy to hurt their child. I think you're part of it wonder while they recall to begin with because they know more than I do. And they don't care what I say forget it. And which case I forget it. I bail on those conversations because we live in a country where you can choose not to actually while. Here's the thing. I don't know more than you do and at most of us in this community, the skeptics community don't know more than you. Do we can't all be experts in everything I know that a lot of us want to help. So what is a non expert skeptic to do what are one example say a friend or a neighbor of mine says I, you know, I don't vaccinate my kids. 'cause I've heard that, you know, there's toxins in it XYZ is it should I say some. Thing. So there's there's a neighbor scenario, and then, of course, on the internet. What are what are the two top tips? You can give if someone's questioning not necessarily if they're already in the in the far extreme anti vaccine. I mean because they're not just making the decision for themselves or their children. They're making decision for you and your child if your child is exposed to children on backsied Novak a high percent of fact, you take something like the measles vaccine is ninety five percent effective, which is one of the more effective axes. But one at twenty children there for all right risky had gotten measles vaccine. You don't wanna be in a community to Thailand. Vaccinate. 'cause you're that's what happened. So the California. The second part of your question was all right the internet. So I would say. The wheel answer the question. Get calls like I've done my research on the chicken pox, vaccine decided not to get people mean by doing the research. They read other people's opinions of Maxine the that's really not doing your research. If you want to do research read, the three hundred articles that have been published on chicken box, which would mean you have to have some expertise in Veraldi's Satistics, biology algae, which most people don't have the most doctors don't have. So what do you do you what we turn to experts at least collectively had that advice that advise the centers for disease control and prevention in the American cabinet pediatrics, and those are the experts that have given said, okay, here's the data. I think we can recommend this axiom. Be given this time in this age group x number of those because they they have looked at all the order, but nobody's going to buy that right in the twenty th century trust, this were experts. So I think what what the best you can do is these go to reputable sites. It's not that hard. I mean, I think that sites possible Philadelphia. The mayo clinic the American Academy the address sites that are university affiliated hospital -ffiliated. Raca democ societies affiliated don't go to those sites that sell something as being a conspiracy. Don't go to sites that sell things. I mean, they're selling on chores that should be a hint chanting. Oh, by the way, here's an ion rearranging machine that can make your autism. That should be a clue that this is not a reputable site autism cures part of it is enough to drive me nuts. And then here's here's something. I'll close with something that I've been interested in wondering if you can fill me in on what you know, I've been hearing from more and more parents who are divorced and one is anti vaccine and one is not anti vaccine. So there are the legal issues of compromising on what vaccine their child gets doesn't get have you encountered this in. How has this been playing out in the real world court? Maybe the parents go to court and usually the mother and father each get their own lawyers who then try and argue for the job shooter shouldn't be accidental. It's ugly. Either lawyers that in this is it got into that extent. There early lawyers will vaccine side, especially and can't eat like are they all over the country of I know some names, but we're not to talk. Okay. Okay. I'll try I'll try to pick your brain later. But we don't have to talk about it. Now. Interesting. I mean disturbing but interesting, thanks so much for me. Thank you. This has been your host covets obvi-. Thanks again to my guests Carl's inner and all audit point of inquiry is production of the center. Ring ry CFI is five onc- three charitable nonprofit organization whose vision is a world in which evidence science in compassion rather than superstitions pseudoscience or prejudice guide public policy. You can visit us at point of inquiry dot org. Dairy can listen to all of PEO is archived episodes. Learn about me and my co host Jim Underdown and support the show and CF advocacy work by clicking the blue support. But another site, please remember to subscribe in share with your friends where available on I tunes, Google play Spotify and other podcast apps. Thanks sense. You again in two weeks.

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Is Genetic Testing Helpful or Harmful?

Functional Medicine Research with Dr. Nikolas Hedberg

1:09:18 hr | 4 months ago

Is Genetic Testing Helpful or Harmful?

"Welcome to the doctor Hedberg show for cutting edge, practical health information for the latest articles, videos and podcasts visit Dr Hedberg Dot Com. That's D R e.. D. R., G. DOT COM. The information in this show is intended for educational purposes, only always consult your healthcare professional before attempting anything recommended in this program and now here's Doctor Hedberg. Welcome everyone. Medicine Research on Dr, Hedberg and very excited today to have Dr. Tommy would on the show. We're going to be talking about genetics and genetic testing. and Dr would is a research assistant professor of Pediatrics and the University of Washington Division of neonatologist. Most of his academic work is focused on developing therapies for brain injury and newborn infants, but also includes adult neuro, degenerative and metabolic diseases as well as nutritional approaches to sports performance. Tommy received an undergraduate degree in biochemistry from the University of Cambridge before obtaining his medical degree from the University of Oxford After working as a doctor in central London Move Norway for his PhD and then to the University of Washington as Post Doc. So in addition to his academic training, he's coached athletes and dozens of sports weekend warriors to Olympia world champions. He's the outgoing president of the Physicians for ancestral. Health Society A director of the British Society of lifestyle medicine and sits on the scientific. Advisory, board of Hinson performance, which includes researching performance optimization strategies for Formula One drivers. Tommy's current research interests include the physiological and metabolic responses, the brain injury and their long-term effects on brain health as well as developing easily accessible methods with which the track human health performance and longevity. Doctor would welcome to the show. Thanks so much for having me. I'm excited to be here. Great. So. Before we got on. We were just talking about. A lot of the big issues in functional medicine include. Scientific and on validated testing and therapies and things like that. And, so that's why I was really looking forward to this. Because genetics is something that I've never really got on board with as far as testing and. Treating patients, so why don't we lay some bedrock for the listeners and if you could just? Let us know what is the current academic position by scientists on commercial genetic testing for snips and the interventions that. That some practitioners are using. That's a great question and. Having. Spent a lot of time sort of straddling both traditional allopathic medicine, traditional academic research, and then also functional medicine, particularly with athletes, but also with various clients with chronic health conditions. This real tension between the two in terms of what's what's done and the evidence that supports it, and I think that's that's where some of this genetics. Stuff comes into play and. When I started looking into this? You see very rapidly that. Academic geneticists who have been studying this these things for you know. To be two decades nowadays since the beginning of the human genome, project. The current state of the science would say that the rates consumer tests single nucleotide polymorphisms. Essentially useless in terms of their ability to either predict disease, risk or say response to a personalized. Nutritional supplements a regimen based on snips. Because most a the disease risk is is usually very small when you know if there is an increased risk associated with a snip and then. The vast majority. Ninety nine point, nine nine percent of suggested inventions based on snips just haven't been rigorously tested in any kind of clinical trial, so if you will get to ask academic geneticists about Darts, consumer tested actionable advice based on them. They would tell you. There's basically nothing that you can do with your twenty three and me for example. Right I. Do want to mention your paper for those interested. The title is using synthetic data sets to bridge the gap between the promise and reality, abasing health related decisions on common single nuclear tied polymorphisms. It's a great paper. It is freely available in all linked to that, so everyone can read it Let's just talk a little bit about. How these things are actually studied so when we're looking at disease, risk and genetics. What are the problems with the methodology in these studies from your point of view? So the main well, there's two two ways that you might look at. The heritage Bitsy of a certain. phenotype, so say a beast tea or an increase in BMI is perhaps one of the ones that was I looked at. And you can do twin and family studies, which tried sort of icy lately. Effective genetics, what is passed down from parents to two children the difficult to control for for the effects of a shared environment But sort of looking at population in general. You might do something genome. Wide Association study where you look at hopefully hundreds of thousands of people and then. Maybe millions of potential snips. And you look at which particular snips might be associated with a given phenotype, so say at increased risk of obesity all an elevated average BMI. And then from there, you sort of can can dig a bit further and tried to quantify. The effect. There is a problem with doing that because you're looking at more snips than you have people to study and FA statiscal reasons, this basically means you'll likely to to overestimate the effect size of a given snip. and. That's that's one aspect, but then when you tryin. Quantify the effect and then report it back, so you might want to tell somebody that is a given effect size of say. An F., T. O. snips or the fat and beastie associated protein. Is One snow in the that's probably the single snap is most associated with an increase in BMI or risk of. And they might say on average if you have one copy. You'll be am. I is point three higher. This is about two pounds in buddy. Wait for an average person, and then it's double that if you have two copies of Ezekiel have. Either one two zero copies of given snip. The the problem there is that. Those are based on singular averages. So you know you take the mean you add up all be a miser, everybody with a given genus hype. And you divide that by the the the number of people, and then you do the same for those with a snip, and then just on average, you might see a slight increase. The real problem comes from the there is so much variability which is lost when you try and describe the average increase. So the thing that I did in the paper was using. Basic Statistical Theory if somebody tells you the mean and standard, the standard deviation of sapien forgiven snippet. You can then reconstruct. A full set that had the follows a cousy and will normal distribution. which it should And then you can look at say how much does. The the full distribution of BMI is in those with a high a higher risk gene type overlap with those with a lower risk genotype and you can do that the any. Single Utah he could do it with a pledge in at risk goals as you know, multiple snips affect. The same a disease or disease risk. And what you start to see or what we saw. Is that. For most single snips that people are talking about in terms of disease risk, there is more than ninety percents overlap between the high risk in the low risk. Gina types so that means that if you have say two copies of the Higher Risk Seo snip. You still ninety percent of the people with that Gina type would have a BMI that is perfectly in keeping with a low risk. Gina type so then only ten percent of people might have a beer by that. That is associated with with an increased risk Ju Ju to type. And, so that's a very different way of talking about risk, so so if somebody just talks about the average effects, they might say oh. You'll going to be on average four pounds heavier. Whereas in reality, there are probably less than ten percent of people who will see any effects on their weight because of their genes aside. And when you look at the effect of the Gina type on BMI in total SEO. Gina type explains things about naught point, two percent of the very busy BMI it's. It's you know it's so tiny that is this basically inconsequential? I'd like to take a quick moment to make you aware of some important resources that are available to you. The first is to make you aware that I not only see patients in my practice. Nashville north, Carolina but I also have a virtual practice where I consult with patients worldwide through telehealth. So it doesn't matter where you live in the world, we consult through our telehealth software. The second resource is the resources page on my website where I list all of the supplements and products I use both personally and in my practice. This can be found at Dr Hedberg dot com forward slash resources. And the third resource for healthcare practitioners who want to learn functional medicine or improve their functional medicine skills. I offer online functional medicine courses at the Hedberg Institute. which is my online functional medicine education platform. You can see all the courses. I offer at HEDBERG INSTITUTE DOT COM and sign up to watch sample course video at no charge. That's Hedberg institute DOT COM and now back to the show. You that was so interesting about your paper. I mean some of these numbers. For some of the SNIPS that you mention. You know the overall. The actual impact on the individual was sometimes less than one percent, no point four percent. Point zero nine two point zero five percent I mean. That alone. Is Not factoring in all of the factors in an individual's life on top of that I mean we don't know if they were breastfed or fed formula, or if they had a lot of antibiotics, the first three years of life. We don't know they're necessarily. You know smoking exercise. Adverse childhood experiences I mean there's so many factors. That could come into play and these these numbers. Do you agree with that or do you think that there's been a good job of? Of Taking into account all of those confounding factors. So in the studies. You know as they do. The you know these Genome Wide Association Studies. And similarly with and Deleon randomize Asian Studies of the effective say a wide range of. LDL, cholesterol levels or homocysteine levels on. On disease risk. The, the baseline is assumption is if you look a large enough group of people than the effects of those exposures kind of disappear. So they don't account for them, because they assume that they have a large enough group size. It shouldn't be a problem and to some extent that is, that is true. And when you look. At the totality of the data that exists on. snips in their. Their effects on, any given, disease risk. In reality almost all of it is driven by the environments. And so those are all the things you mentioned and in particular when you're looking. At some of these snip so so again. ABC types diabetes. These. Are Diseases the a very common in industrialized societies. And if you look at, say apologetic risk, so you take all of the you take all of the snaps associated with obesity and the most recent paper I think one hundred and forty one total sniffs to create apologetic risk cool. But even those in the lowest risk genetic group, which is actually relatively read. That BMI was over twenty five so on average, even in the lowest risk genetic group. These people are overweight. And what I think re tells you is the if there isn't affected these snips, which is over what is very small, so in that paper? They said the one hundred forty one snaps. Predicted all was associated with thirteen percent in the variation NBA saying the eighty seven percent is directly driven by. Other factors in the environment. But these you can only say that this is the case even that thirteen percent and a population that is you know, baseline. Overweight or obese? And in the setting of modern westernized environment so once you take those facts away. If you'll know, you're working with a patient or yourself Removing some of these factors or changing your environment, you don't have the same genyk environment as the average industrialized population does. These snips become even less important. Interesting. Yes, that's why I wanted to have you on. Because your knowledge of statistics is exceptional, and and really understanding the so. So we talked a little bit about obesity, and it's just the psychology in this is really interesting, because people who. Some people just say yeah. You know I've got the fat gene There's not much I can do about it, but just the peers that that has very little impact on on the individual's ability to maintain. Normal BMI. and. When I was doing the graduate level. Courses in molecular genetics. Janet professor. He kind of explained these A. Way To explain it to to lay people is that? He snips. Genes are like an audio dial. You want to say a scale of one to ten, and they can be turned up to attend or turn down to a one based on all the factors in the individual's life. Sleep exercise stress nutrition, etc.. And I thought that was kind of interesting way of explaining it and. That's something that I. Think a lot of people don't understand. They think that if they have the snip. Then it's just one hundred percent. Active all the time and there's nothing they can do about it for the rest of their life. What do you think about that way of looking at? Yeah, I think this. Deterministic view of genetics. Really has all should have. died out as as we learned more and more about the genome apogee genome the sort of the interactions that occur there and. When you look at certain snaps will send genes based on maybe multiple snips. You might have a range of different functions. But. That tells you about the Funk, so so so say a snip. Or a gene encodes for a protein is an enzyme. And based on snips, the enzyme function my increase or decrease in absolutely it can be. Is probably you know it's unlikely that it's going to go all the way down to zero on the volume scale? But maybe it's going to be somewhere between. Three and ten thirty to seventy percent. with one hundred percents something like that. And so if you measure the activity of the enzyme and the test tube, you'll see that there's an effect that is less active enzyme. But when you think about what Jean does, and how it fits into sort of the systems within a body, so you you have the the activity of the enzyme itself, but then it does something right so it it has a substrate and product, and you know some things will be required to make the substrate and something's will end. The product will maybe do something as well. Well and those are going to feedback and tell the Saudi twenty make more or less of this protein, and they're gonna be all these other factors likes Acadian is going to is going to change transcription factors, which is gonNA change the level of of of the protein, and maybe maybe you're going to need some some cofactors awesome, some vitamins and nutrients for that system to function. So say I have. A combination of snips that reduces a the function of one of my enzymes fifty percent. Because of a combination of things, maybe I just make twice as much enzyme, and then I have essentially one hundred percent function. Or maybe all those other factors come into play, if I if I make sure that I maintain US Acadian with him and I have a good nutrients stasis by deceasing. Wide Range of nutrient dense foods. None of this matters anymore so. It's you see people. Talk about you know x percent function of a gene, but thus have you know even for that pathway? That gene has a very small part to play in terms of all the things you know, the the amount that gene is transcribed, the number proteins made all the different cofactors substrates things that are gonNA feed into that system and in reality you know maybe some balances found that means at this reading, no overall meaningful change in function of the system I think that's really what's happening. Most people have some slight changes in in function of genes and proteins, but the same overall balance is maintained as long as you know the necessary inputs there. Let's. Get. Into some specific snips. Let's let's cover the elephant in the room I which. MTA chaffar. this is this is definitely been the most frustrating for me as a practitioner talking to patients about MTA far because a lot of them will come in. Believing that it's a it's a serious part of their illness. It's. It's It's having a major impact and a cause of their disease and their symptoms. And everything they're that they're going through. And part of that is because of what they read online, and what people are talking about and forums and groups. And then you'll hear claims of well, you know. Nothing really worked for me until I just took a lot of methylated fully. And one of the things people need to understand is that there's any I mean studies show? There's anywhere from about forty to a ninety percent chance of placebo effect. If, you believe something is going to work for you. And so that's the first thing that comes into play. Then the other aspect is practitioners claiming that it's it's very important and every time I asked them well. What else did you do with the patient to the patient? Just come in. And you gave the methylated fully, and that was it. and that's never the case. It's always big changes to the Diet. Exercise other supplements so many different interventions going on, and so how can you single out an intervention like that as the cause of the patient getting better? So. What is your overall Take on on MTA far and what the research shows, and is it actually something that we should worry about or Or is it something we should just put aside? The MTA chief, obviously, if you've. Spent time in the functional medicine a Rena. It's you're right. It's that it's the elephant in the room and it's also a nice case study. Because like I intimated before there are two snips the most commonly talked about in the taste for gene. A once United C and C six seven seven T, and you can have you know one or two copies of either and they interact to create different levels of of gene function, so you can look at a fee type based on the percent function of the enzyme, which is reading, which is really nice sort of you. There's there's a rage. And so? It's worth I. saying that's more than eighty. Five percent of people have at least one of those snips results in less than one hundred percent Jean function right so the vast majority of people have as I've heard you know quite. You know smart. People say they have a an MTA. Gene that doesn't work properly, right? That's that's the language that immediately is brought forward. When you start talking about this which you know if if if that's the standard right, then then. Obviously, that's not true. You meant to begin with. So, you know I found this interesting for me because I have one copy of each knit, which means that I have more than fifty percent loss of the function of my gene. O of my notes MTA Chapelle protein if we look at it in test you. Like about it. So one of the ways that you can look MTA. Function In terms of a phenotype is home assistant level. And that's not perfect right? There are multiple escape pathways sixteen. It's not just affected by MTA Jaffar function. However, you know there are plenty of studies that look hat MTA. G Type and Tom Assisting so you can look at what effect you'll snip might have on or snips might have on your high Mississippi level and so. I did this in in a similar way. It's in the paper. People can go take a look at it. And what you see is first of all. The effect isn't linear, which is what most people assume when they're saying you know you have X. percent reduction in function, so you need X. percent more Co lead on with AFO night so that I see that's not true. And secondly, if you look across the range of the most common MTA, Chevelle snips and combinations. You'll MTA. Shofar genius hype. Basically. Explains About eight percent in the variability in home, assisting which is just a tiny amount considering like how how much people say. How important MTA shofar is a function of of this system. And in reality. All these you know so many things going to come into play and when you look at one specific outcome like homocysteine. Is Basically. Is Basically meaningless in terms of what your home assistant level is, and I find it really interesting because when I when I speak about. This so much pushback because they've you know. That's in empty. Asia is important. I remember being two to one to one is coach. She was saying that for them. You know knowing about M.. C. H. was reading it because it meant that they sort of. They found out that their home assistant level was elevated, and they did something. You know they I. Think they say you know. Improve that slightly maybe a bit more choline. and. Then things improved but I would. Ask? What does knowledge about the MTA gene assist with? If you just measured your phenotype right if you just measure sixteen level? What does knowing about MCA shofar do to improve your ability to act on that. And in reality there isn't any people have sort of attached this this level of importance So when you when you look and say Shofar and various outcomes. the the research is incredibly mixed Sometimes, it's postive, sometimes negative. If you if you really dig into the details, I'd say that most of the time it's. It doesn't really have any effect. But but you know it's hard to hear and that's. That's the one where I've gotten the most pushback. Despite the fact that. You know if you find the papers that you think say. MTA Shofar is associated with a given outcome. In my paper all the tools that you can use to prove me wrong and I'm very happy for you to do that. The there's nothing hidden there you all. You can use freely online available tools. You can dig into that yourself and I oversee Kant. No of it's shock on all the papers but you want people to to better understand how they can look at this themselves and I'm you know based on what I've seen I don't think MTA, pause really anything to worry about the most people as long as they have an adequate states, a decent diet and Minimize exposure to various environmental toxins, and over the next size, and all that kind of stuff of which I would, I would say that for anybody regardless of that of that genotypes. Exactly and I I. DO explain that the patients it's just not. This is just not really important and It, was it was it was my understanding about MTA far? Just looking at the whole biochemistry of it was if you had. If you're just if you get a have adequate, b twelve full eight, and and you know some adequate choline in your diet. And some and of course Riboflavin. that's I. Mean that's kind of it as far as the building blocks. To just make sure everything's working well in that pathway. Do you have anything to add to that? No I think that's that that that's it really and the Riboflavin is a great point because these these snips they basically affects the ability of the MCA. Enzyme to to bind to Eddie to which is which is made from Riboflavin, and there's some nice studies showing the, but typically with this those who are homeless I guess further six seven seventy Those guys have. About seventy five percent reduction in their enzyme function at a much greater variability. In the homocysteine levels compared to to everybody else, so that's why the effect isn't linear. But if you give those guys, just a tiny arrive and I think this study gives gave him one point six milligrams. Then that significantly reduces the homocysteine levels. So If. You a nutrient replete and again it's. Produce would require you to eat. You know occasionally a few eggs and some liver. Maybe. You know some some some meat fish That's GONNA. Do Most of the job. And I. Don't think you need to really worry about it beyond the. Agreed I. I did do a deep dive into the far. I think it was last year. I wasn't able to find any evidence that doing any kind of specific intervention really does anything as far as symptoms or reducing disease risk. In fact, the geneticists that I read their statements basically echoed that that. There's there's no evidence that. Treating, MTA chaffar really does anything. So. On that as well, yes. In line with that? I I. Put my my twenty-three inmates into an online choline calculator a which was supposed to tell me how much extra coating I should eat based on my My MTA Jaffar for and. And and one of the paper, and so the main paper that the recommendations based on. Over we'll have fifty percent loss in function so I should eat twice as much coding as you know as somebody. One hundred percent function was cut was kind of fish. Calculator said, but the the paper that was referenced was a paper where they gave extra choline to thirteen four late deficient. Mexican American men. So it's a tiny sample size. We know the s misty and race play a huge role in whether snips of penetration on not I'm and there was the confounded. The this group was already late efficient. And then they looked at methylation function. Our like total methylation and. Even despite giving them extra choline, there was actually no difference in methylation, but then this was the paper that was being used to recommend that twice as much coding so. Just so many parts of that make no sense whatsoever. And and like you say when you look. There s interventions None of them show a significant. Effect one way or the other and people with varying levels of anti-asia function. Yeah it's. It's difficult to navigate this this industry because. There's so many papers that you have to read to understand everything in fact, check everything and I understand why. Not every practitioner is doing that or has the time to do that I. Mean You almost need a research team to investigate every single thing that you're doing? And everybody does the best that they can. But it's interesting. You brought that up about the study was done on people with a fully deficiency, and you can let me know if you agree with this or not, but almost all of the papers that I read on micronutrients. You always get great results when the participants are deficient in that particular nutrient. But, not if there's sufficiency, so there's no, they're rarely any studies that I'm aware of where if the patient has sufficient levels of micronutrient that their body needs. Excess amounts. Don't necessarily. Give you exceptional outcomes. Would you agree with that? Or are there any cases where you you might disagree? Now I absolutely I think that's. There's obviously a baseline level that we require and I think for many nutrients Probably the majority of people eating a a westernized diets will be deficient or at least insufficient in those, and if you supplement with them, you will see. You will see benefits however Like you say I think particularly people listening to this podcast the patients. If you're recommending a nutrient, dense diet, and maybe do some. I would do some phenotype testing where you test for a level a given nutrient. Ideally in the blood, because we understand those much better than some of the other tests. And if somebody is deficient insufficient, you replace that you'll see benefit, but but beyond that. You. Know you almost never. See see benefit, and you know in some cases you may actually cause harm by by adding loads of some particular. Variant of a neutral to a system that that doesn't need it. Right. Right. Let's jump into the second of big snip. That's talked about. At least this is the one that I tend to common contact with the most with with patients and practitioners. Is Com t? In, this is the you know. The idea is that you're either a worrier or a warrior depending on your your CEO MT gene. Can you explain that and what the the actual impact is having? Co Mt. if there is any impact, yeah, absolutely this this this one again. When you look at this yourself, you can always find an interesting story that you want to want to better understand so so with the. Sierra Mt Gene There is a snip cools the change in amino acid. In Casco Low Michele transfers If you have two copies of the Methionine, snip then how foster supposedly a foster emt activity this means you a breakdown dopamine much faster so you have less dopamine in your prefrontal CORTEX. This makes you better. more more resilient to stress, but you have a low IQ and low executive function. So that's me. So if you're listening to me, talk about this stuff. Remember the I have a low IQ and poor executive function, so you probably know worth listening to anything. Conversely if you have two copies of the veiling version, then you have slow activity modes opening supposedly that means you have more likely to be anxious, but you have a higher. I Q and high executive function, and this is sort of. What is what is generally said about those those snips? And so what? What you might actually be interested in me, probably recap. How much does make is in your prefrontal Cortex? Care about cognitive function say so. If you look at the largest. looking at CNN t snips and their effects on various metrics of cognitive function. You know the big ones where you looking. At several hundred people basically say the VIZ, no difference. It doesn't make any difference. And so, if you really dig down you through the tests, I did find one study that looked at five hundred people. And, they found that those who? Were the warrior type foster CMT activity. They perform slightly this well in a version of the number test, which is where you give people a collection of numbers in medicine, the method recite them back in alphabetical numerical order. And then I did an analysis on this on this data, and about full percents of the of the variability in performance in the test was explained by. so again you know more than ninety five percent. Ju To everything else that the plays into cognitive function. But when you really dig into this and this is. One of My favorite personal stories as the genetics. I was looking at. How do we know? About? SNIPS and how they affect the gene function. And there's one original paper which everybody sites back to and they took the brains of cadavers. And they look to the Gina Type, and then they extracted com t from the brain and they look today. In Test Tube. And those who had the warriors type had on average thirty eight percent. Greater activity than the warriors. But interestingly, if you then try and reconstruct a full day set, the describes the full variability but like I like I've done in the paper for the fierceness as well. What you see. Is that actually? The dates that they present. Is Inaccurate in the paper because? The they don't tell you what the Arabs are. They just give you a groff, and then an Arab until you with Arab are is. But, if you sort of like by you know sort of deduction, you can figure out the the way the described the dates set. Is Inaccurate because they're assuming that it's distributed when it isn't. This vast very busy. If you try and reconstruct, states set the the the random number generator the US once said to be negative numbers, which is impossible to to make the way make the day to fit the way. It's described in the paper. And this makes perfect sense. If you try and understand it, if you if you do understand how these studies at done, so if you have to take cadavers, and is it going to be a certain amount of time? Before you. Get access to the tissues and we sent them out of time. If you process it, look at it, you know. All of that is going to result in huge variability in the data. And that's just to be expected. If you do those kinds of studies, so so the the original study that everybody sites back to say that this snip associated with x percent change in function of Sierra, Mt. Basically because of the way the study was done. Really Trust the data. And so like, but but nobody really thinks about. So so even like if I tell you, that is a thirty eight percent difference function. The pro, even true, but that's that's again. These myths propagated. Forwards because this sort of helps us tell a story. But Hey. The original data probably isn't trustworthy and be. If you then do look at snips in Congress a function. They don't really make any difference. Exactly. And I I have patients who believe that this is the single cause of their you know their depression or the anxiety for their mental illness and that alone as we talked about earlier is enough to affect the biochemistry so sitting. And that kind of ties in with the crib one which I just want to have us, talk, about couple of these athletic type snips so crab won the endurance. gene and was what was interesting about this that you wrote. Is that if you? If you think you don't have the endurance gene, this actually affects your performance regardless of the actual. Gino types can you talk about? One endurance. Yeah this. This is a a brilliant paper that came out in nature, even behavior yeah! Two thousand nine hundred. And they they took people and they made them do. A treadmill test? and. They looked at their performance on standardized tests, and then they took their. Know they? They mentioned that gene talk of this gene, a crab one, which is a associated with improved aerobic performance. And then they told the participants, either they had the good version of of the gene so that you know they were going to be have a good version of the aerobic gene, or they had the by version rights, a two copies of the Bat Bush of the aerobic gene. And, then they retested them. And they found that those who were told they had the good version did about the same as they did on the first test treadmill test? Those who told they had the pad version did was. So being told that they want genetically good. Aerobic endurance made them perform less well. And they're. Just dramatically increasing number of examples of of of this being told that there's something about your physiology will is is going to have a much bigger effects thinking that you're going to have an effect is much bigger than the effect itself so that those those effects on people's performance happened regardless of what their actual gina type, watts and in in the same paper. They told people about their. MTO SNIPS again the obesity risk. And Ben they did standard meals. An look to their society, and if they were told that they had the high risk, the lowest unit type that actually changed the the hormone levels that gop one and their with one of the increase in the Gut, associated with society signaling, and their actual feelings of SOC- society off to the same meal, so being told that you have sent units hyper Galveston the jeans she has you actually have. Changes hormonal signaling, it changes levels of hormones associated with that process. And you'll see this again again, I am just bring this up is a tangent, but just because I was reading these the other day. There were two recent studies that look sleep trackers. And they randomized people to tell them whether they had good or poor. Sleep the night before and regardless of how they actually slept those who told that they had poor sleep. Performed less well in cognitive tests and felt sleepy during the day, even though it had nothing to do with how well they actually slept, so there were all these things that you do in the sort of functional medicine space. That if they don't the the US, you have a much bigger effects based on what you tell the patient raw than what is actually going on either that genetic or Pull, on C. Sleep tracking, you can have your muscle, and you're much more likely to have a negative effects than have a positive effect you know like like with the insurance gene to being told that you have the good gene makes you perform just as well right, so can never get better. You just get worse based on on what what what people are telling you based on genetic, so this huge amount harm that you can do when you talk about. That Eugene isn't working properly. This is the language this this used around H. Afar, and similarly watching a video. Somebody sent me on obesity day, and those those doctor saying that seventy percent. Of struggling with the beastie is genetic, and that's incredibly disempowering. You'll basically telling somebody that there's nothing they can do about it because it's a wooden there in is, it's all in their genes, which you know, even if there isn't effect of genes, is all driven by the environment which you do, have control over right is a huge amount that you can empower yourself if you look at it from the right. But that's not what most people. My listeners know that I have a deep interest in psycho, neuro immunology, and so this doesn't necessarily surprise me. Actually 'cause I could bring up a few examples. In, for example, the pain literature. If a doctor and authority figure you know shows you an MRI or an x Ray, and says you know you have this. You're going to have it. You know for the rest of your life. That actually has a significant impact on the patient's pain level going forward. Just being told that they have a problem. And they see it on the film, and they're told that by an authority figure, and then people were given Two tubes of of cream and had the exact same cream in it, but one one tube was labeled cream, and the other one was labelled a cold cream and they all reported. feeling you know a burning or a hot feeling from the one labeled hot, even though it was the exact same as the cold. And and the people had the cold to. said that they actually feel cold. From the cream, even though the cream had no no impact on temperature. So. Many studies like that about what we believe. Effects are biochemistry. From allergies to health, and then these things that you're talking about with. Durrance, so it's just a really fascinating. Field to to look into. Act N three is the other kind of athletic Snip to talk about can. Other any, is there anything you want to talk about a and three? Yeah, absolutely so. There are. I mean at this point. There are dozens of snips that people talk about in terms of say response to exercise or train a bit of CEO, and then use. It's try and give you some. You're just like people. Using snips teddy how to eat switch certainly is an evidence base that, during the same things for training and this again I, I have a story behind this because like you mentioned in the beginning I work with some some Formula One drivers and It's it's very popular, or if you, if you have some kind of device, protest or something, and you can get it in the hands of Formula One, driver It's it's great. Feel Marketing, right? There are these A. By various metrics, the best motorsports drivers in the world, and they're only ever twins you all the time, so these are very rare individuals in terms of being able to work within this and his great. If you can say, Oh, yeah. So and so person. Driving used by tests or use my device or whatever? So I was sent the results by the coach of one of the drivers of genetic training. Tests, so so they. They tested this guy's genetics and they gave him a report. And one of the things that came up. was you know they looked to three or four genes on muscle fiber type? And One he he, he had two copies of this snip and the men of the ACTONEL for three gene. And In his report? This is a big red light. This this bad. And, then it says proportion of five is low than the general population which recalls Utah Lower Response to strength training. Now bear in mind. This is one of like the fittest people you know a in motorsports, but also compared to the general population just incredibly fit. Talk Point something something. And so you know. To begin with that doesn't make any sense, but but then know there's no references attached to that. But what really bothers me is in line the other things that we. Talked about is that. You'll telling. An elite athlete that's their training isn't going to work for them, so you're telling them that. They're not going to respond well to training, which is then going to affect that performance right and that performance involves driving a concrete wall at two hundred miles an hour. And as soon as you start trying to introduce non evidence, based thoughts into that process I do have a big problem with that. And? When you look at the statements, there's no references of course anywhere in the report so then I'll go and dig into this and look and see what I can find. And one main study. That looked at act. N. Gina Type and response the training. and had. About Sixty people. Hoffman Hof women. And they did see. A statistical trend in terms of response to training in Dhaka peak power change in terms after a chunk of training. So, it wasn't significant, but there was a statistical trend between those who are two copies of good versions copies of the bat version. But this was in a group of older men and women over sixty five doing training training three times a week, doing four to five sets of ten leg extensions. Which is just not relevant? A toll to the athlete who is who is being told that they're not going to respond to strength training. You know this this athlete. And there's no studies in a population that might be relevant to him. And again, if I, if I eat, so I use this data, even though isn't great. Trying to the same thing and then ACN type may explain you know five or six percent of your response to strain so again it's tiny fraction compared to all these other things, which actually even in Formula One driver. All the other lifestyle environment factors are going to play a much bigger. Oh, because these guys are in a different time zone every week. traveling continuously high stress so there are all these other things that you are going to be so much more important. I'm so not only. Have you negatively affected so the cognitive aspects of the training? You also the you know everything else is going to be so much more important. And I know people who are tailoring their entire exercise routine around these once they find out some I've known people who quit running and just change to running sprints based on this and also completely changing their. Their Rep skiing and you know the amount of weight, lifting and things like that. If they're fast, twitch versus slow, twitch The an so there was one study that came out sponsored by a company called DNA Fay in the. UK came out few years ago. Now the the randomized people based on their genetics to. A different training methodology based on where they were largely endurance or strength type, and then they looked at their Both Training Both training. Programs Sort of resistance base than they looked at various different performance metrics and muscle game. and for those who had like a synchronous like they're that Gina hype and the and the training program they were randomized to lined up. Seem to do the best however. I mean you you, you think. Wow, you know that's. That's really important. You know this is. This is going to be something that we're gonNA. See a lot more of. Nobody has been able to reproduce those results. There is no other study the randomized to training methodologies based on their genetics and then sees you know then then they see benefit from. Tailoring based on genetics, so you know there was this one paper that made me super excited about. This is a possibility back when I also had more faith in in snip testing as as a as a personalization method anyway. But it just hasn't been. Nobody's been able to do the same. Nobody's mount. You know there's published anything similar so so there's really again no evidence to support that approach. And the same thing with eating correct so the fat versus the Carb Gino type. Can you talk a little bit about that yeah yeah. There's a number of snips the supposedly associated with. Your best responses to too low carb versus high carb diets. And actually right at the beginning of of me getting into all this that was Saute I had a very well known functional medicine practitioner to say. I said I'm a I'm a low CARB GINA type, but my partner is a high Cobb gene. It's up or something like that and I. was you know immediately? I was like okay. This is something I need to to here and. When when you look at the data that exists again. So you have these Genome Wide Association Studies. And not only of the Genome Wide Association studies flawed in their own ways that we talked about earlier. It doesn't mean they shouldn't be done, but it just means that there's. Some caveats to that, and then you introduce another factor, which was nutritional epidemiology, which is. Basically nonsense I'm most of the time because you just don't know what people are eating despite what they tell you that everything, and then you sort of into those and out pops some jeans, supposedly going to be better. Tell you whether you should eat low cobble fat. and. There are no interventional trials that show that there is a meaningful effect there I. Think the best one that's been done to date was the Diet fits trial that people may have had a Christopher Gardner is sort of a a very well known researcher in that space, and they randomized people to either low Kabul low fat diets. On whole foods in general, so they dramatically improve food quantity, and then after like a certain amount of restriction than people were told you know, find a level of Kabul fat intake is sustainable for you. And what then they did a post doc analysis like a secondary analysis of of the results, so the initial results said that it doesn't matter if you're fat, if you improve quality and find something sustainable, then weight loss is the same. And then they looked at people's genetics, and they separated people into being a low kaci his. A low fat genotype or a mixture of the two? It wasn't really a clear signal, one way or the other. And regardless GINA type, and regardless of of which diet you a randomized to everybody the same amount of weight. So so there's really nothing again that says Oh. Yes, you'll. Somebody should be more cop, so you'll. Somebody should be beating more fat based on your genes. Yeah, Exactly, and there's two more snips. I just wanted to squeeze in. You and I had exchanged some emails this past week about these the VR. The vitamin D receptor. the the current understanding among a lot of practitioners. Is that if you have? The vitamin D, receptor polymorphism. You're at an increased risk of autoimmune disease. And what? What did you find in your analysis of that Yeah I spent some time looking at this the. Yesterday in fact. there. They're full video snips. The sort of talked about faulk. BE SM APA and tack and. Unlike most other snips these are actually. Named based on a bacterial restriction enzyme cleavage site, so this is kind of the the old old school method of trying to figure out types of of gene typing I wish people may have learned with if they lent by chemistry in in in College and so these are the full. They've looked at in terms of association with ultimate disease and Hashimoto's Thyroiditis, a particular property. You know 'cause. Common. People are very interested in the section with with Vitamin D and BITs mathie metabolism so. Looking at three math analyses so again, not just looking at single study looking it multiple generations. Multiple different data sets The so massive I found said that TAC was associated with decreased risk in. An African populations bsn was associated with a decreased risk in African and European populations, but an increased risk in Asian populations. An APA was associated with an increased risk and African populations. So that's one. Increase, the risk, st embrace any seemed to play a role. Then the next maximalists says well as an increased risk with tact, but not with APA and Faulk, and then the next man's says well fuck is associated with increased risk in Asians, but not any other population, and there's no effect of the other ones. So, if you you know if you're gonNA do a method analysis in reality does no overall discernible effect here. And this is you know. The more you look at these various studies. Certainly you might be able to find an effect in a certain population, and maybe that becomes important depending on the patient in front of you but overall. I would say that there's no discernible by meaningful. The fact of any of these snaps on risk of say Hush macy's. Excellent. And then the last one is the glutathione. S transferase salute the claim by some practitioners? Is that if they have this GST SNIP? They will have difficulty producing glutathione if they supplement with an Acetyl, sistine or something like a quarter. And again just kind of anecdotal reports from practitioners, practices, and things like that that you find anything that substantiates that claim that someone should just take glutathione on its own if they have the snip as opposed to say NBC. So I think it's an interesting claim to make because just T- isn't involved in the synthesis of boots. thion is involved in the use of Lutheran right so it's the conjugation of goods thion to a molecule that contains a free radical There are two main. GST snips that the people talk about the m one and the t one null mutation you might read about, and they are associated with a decreased level and function of GST enzyme. And depending on the study may be may increase your risk of certain cancers. If you smoke, it may increase your risk of copd a property just because you're not quite as good at. A falling into the trap of ten to be good at this. But you know the cause of the function of the enzyme you might be able to clear as much of the radicals, but will that again at the end. Is Worth saying these are very very common snips. So, more than fifty percent of all the GST feels in European populations. M One though us that means that more than fifty percent of people have or around fifty percent of people have one copy and twenty five percent of people on average will have. Two copies in East Asian populations. Nearly fifty percent off t. one, though both very common depending on the country in African populations. You might have twins to fifty percent of each in different ratios, so you know again. Probably the majority of people are going to have at least one copy of one of these snips. So. When you then look at? Studies of of whether people with GNC snips respond to knack. Which is the specific question? Actually you find almost the opposite. So. Knack does seem to reduce the risk of mortality in people with AIDS accuse for she digestion there in intensive care units. And there was another study that looked a changes in hearing based on noise exposure, and again those in with either one or two null snip copies of gs John that she did better on Mackerel. They were the ones that responded to knack. So. There's no evidence to suggest that. If you have a GST, snip, you won't respond to that. And I and I have not seen any evidence that glues thion is better than knack for any important outcome nakas very well studied very understood And you know so so then that. May Be a case to say yes, people you know with these snips, which again very common. Maybe the majority of people compared to the the minority of people don't have these snips. Yes, you may have an increased susceptibility talks to distress bots, you know the advice is going to be the same in terms of nutrient status minimizing exposures maximizing the healthy of the antioxidant system through all metric exposures like exercise you know all of that is gonNA. Be the same regardless of snip, so so yes, maybe a biochemical function, but does that change your advice? Now it doesn't and I think that's the important thing Excellent. So as I said earlier, this is you know it's? It's difficult to navigate for practitioners because you know, we go to functional medicine conferences, and there's a bunch of labs. They're that that offer. Genetic testing and it's presented in a very neat and tidy model where you just run the test. And, then the patient is supposed to take all of these supplements to address their genes. So I think that's one of the reasons why it's taking off. 'cause there's just there's a Lotta money to be made in genetic testing and selling supplements to address The individual snips and that's that's a problem and I am worried about it. I've been worrying about it for a long time, and that's why I'm so glad you were able to come on here and talk about the real science behind it. I think we've covered a lot today. Is there anything else you wanted to add that? You really think practitioners, order or the layperson should know about regarding. GENETIC SNIP testing. I think that that gives a sort of like got a nice broad overview of where the evidence really stands. The most important thing to me is is The if people think this is important. And they want to use it in that practice like a don't necessarily have a problem with that, but you, but you should understand the evidence. That exists behind your recommendations. And like I said if you link to the paper and the tools to really dig into this all off Beth for anybody who's willing to invest invest the time. and it's important because you basically a likely more likely to do harm than good with the current state of the science and I think that's you know I think most practitioners want to do good. They want to help They WANNA help that patients and you know the the the possibility of doing of doing home. Of disempowering the patient by by the these tests, and also incurring unnecessary costs for the tests and supplements I think that's the way we need to step back and say. Is this really worth us? Doing and the vast majority of of evidence suggests that the recommendations should stay the same regardless of of snips regardless of Gina Type. You know that's the way we re really are the moment, and maybe that will change. You know in US fine, but that radio where we are right now, so so I think it's just it's just thinking about how. communicates these things we could. Patience is going to is going to affect their physiology. You know regardless of what the actually does. and so just just thinking about that and really digging into the SNIPS. You think you think they're important so so great. Find the papers you know. Dig into the data. Take into account things like ethnicity which. Play, a big role in terms of overall fina type based on Gina Type, and In general. The the research is very sort of European centric, and similarly more than seventy percent of of the genus types in twenty three. It means database. I'll take it from from white. People so so When when you then try and apply that information to those. Who are black or have you know a other different backgrounds? You know that the data even if it's a small, even if there is a small effect, it becomes even less meaningful so taking all those things into account, really taking the time to sort of understand I. think is really important, and it's just because it's going to. It's going to affect. The outcome of your patients, we should tree believe people are trying to improve. exactly and. Like what he said. You know you do risk doing more harm than good in some individuals and that's that's really kind of the core. Tenant of practice is the last thing you want to do is. Is Do harm. And, so we have to be really careful and prudent about what we choose to do, and and what kind of interventions we want to to use with patients, so. Dr would where would you like people to find you online? The easiest way is probably to follow me on instagram. At doctor, tell me Word on Instagram There's usually I'll place of my own science publications that, but then also you know some some more general training, so some training stuff because that's something that I'm interested in, and you'll see pictures of my boxes My my dogs pop up frequently as well I am at Dr, a g on twitter. Now is my middle name. And I also have a website. Dot Com, although that's kind of falling behind in terms of updates. SO-SO instagram's per probably the best place. Excellent. Well. This has been great. Thank you again for coming on. And for all the listeners go to Dr Hedberg DOT COM. If you want to read a full transcript of this. And we'll have links to Dr Woods paper as well as links to anything else that we talked about. We'll take care everyone Dr Hedberg and I will talk to you next time. If you enjoy the doctor Hedberg show. You can support it by sharing each episode on your social media channels like facebook, and by leaving your review on I tunes please visit Dr Hedberg Dot Com, that's D R HDD b. e., R. G., DOT, com to access the show notes and resources for today's episode.

N. Gina Type MTA MTA obesity US Genome Wide Association Studie Test Tube Doctor Hedberg Ju Ju Dr. Tommy Jean Utah Mt Dr Hedberg Dot Com Hedberg University of Oxford University of Cambridge
Spreading Autism Awareness With Dr. Thomas Frazier Of Autism Speaks

Mom Brain

49:10 min | 1 year ago

Spreading Autism Awareness With Dr. Thomas Frazier Of Autism Speaks

"Lina mom is the toughest job there is and it doesn't come with instructions. So it's okay. If you don't have all the answers figure it out together. This is mom brain with alario Baldwin and Daphne us. Hey, guys. Welcome back to mom brain. I'm Ilaria, and I'm Daphne and today we're talking to Dr Thomas Frazier who is the chief science officer at autismspeaks so US might know, April is autism awareness month. So we wanted to do an episode on the topic. And obviously, you know, an hour barely scratches the surface on this incredible field and the new knowledge that's coming to surface. But we are very lucky to be talking with Dr Frazier. He has so much to say on the subject, and we know you guys are gonna love this episode. And this is a topic that is very emotional for. I think for for almost everybody. I mean, even if we don't have someone in our family who has autism. And there's a lot of really great resources, and, you know, talking to Dr Frazier today, I think taught me I don't know about you Daphne, but Tommy about resources out there. And and kind of and what you do when when this is. Is that something that comes in? Cheerful home. No, it was it was wonderful to hear from him here from him as an expert, but here from him as a father, first and foremost of a son who who struggled with autism and a son who who has been able to benefit from both of his parents as it turns out incredible knowledge in this space and incredible passion for for early intervention, which we talk about the kinds of therapies that have really been proven to help people deal with their environment deal with social cues deal with communication deal with all these different elements of autism. And do it in a really positive way. I think he, you know, I think he'll be really interested to hear the like you said the way that this research is constantly evolving in the way that we're learning so much more about the spectrum of it. And and how how you know, if you're if you're a parent of young children, what are the signs you can be looking for an and aware of? Early on especially because look we are the first line of defense. Your with your kids all the time. We we are we do live in a research society, and everyone goes deep on everything and wants to learn everything and the best thing we can do is prepare ourselves first with right information and then with good therapies and good techniques and good ways of enforcing good behavior. And by the way, that's for all kids something else. He said that I thought was really powerful is a lot of the the interventions or the techniques you might use on on a child with any kind of either learning or behavioral disability is inevitably great for kids of all of all kids. So so I think it'll be really fascinated to hear from him so much great information allowing at barely ever talk. So so that's that's a chance three days. If you guys who are frequent mom, brain listeners. This is the most you will hear us talking visiting tire episode. But yeah, no. I mean, again, this is something that is that is in the works in terms of people understanding it more and more and more. I feel like this is something that all of us can can get together. And and uh. And help with research and help with walks and help with I I is for me. It's this, and it's cancer research is all that really makes my my heart want to to get involved with with other people because I feel like the more that we understand this. You know, the the the better answers that we can have an and you already see that answers are are really coming quickly in this field. So enjoy I'm sure this is going to be fascinating for you. That. So this goes at the beginning, we let reduce your lease to introduce exactly. Exactly user introduced and it never sounds as good as when it's coming from your mouth. Sure. So I'm Thomas Frazier. I'm a clinical psychologist. I joined autism speaks a little over two years ago. And before I was an autism speaks at the Cleveland Clinic. I still live in Cleveland with my family. I have a wonderful wife who I mentioned is a board certified behavior analysts in works with people with autism. And I have two children. My son, Sean is fifteen he has autism and intellectual disability and my daughter, Emily is fourteen and she is probably a little bit too. Neuro typical. So I mean, you know, obviously, this is a big topic. Autism is a big topic. And it's one that over the past. I would say probably can speech us better than us. A couple of decades. It's been understood better and better and early screening is extremely not only important, but it can be helpful and can completely change children's lives and parents lives. So you know, we definitely wanna talk about screening. I wanna talk about you know, I as a mother I have four children and Daphne very soon is going to have for children. And it was it was something that was very nervous about when I had kids. And and you hear these things where you have a completely. I don't want to use the word normal, but average child, and then all of a sudden one day your child turns around and goes into a corner, and and doesn't speak to you anymore. And that idea. Of losing my my child was terrifying to me, and I feel like there's there's not a lot of understanding of surrounding autism. So can you speak to us a little bit about what autism is what are early signs is it something that you believe the kids are born with is it something that happens to kids. First of all, thanks for having me. I really excited to speak with both of you today. It's an honor for me. I think it's really important for people to know early signs, obviously as you said screening is crucial and getting screened early allows us to get them into intervention early in. So that's why we were so focused on this because we know that early intervention matters for kids at changes their developmental trajectories. It really improves the quality of their life the lives of their family if they can get the right treatment. So obviously getting kids in early is really crucial in part of getting kids in early for screening is having parents and other family members understand the signs the really early signs. So. So we so generally, here's what we look for by six months of age your child should be engaging in something called six social smiling where it's sort of a back and forth. If you got your you have multiple children, so you know this. But when they're really little obviously, they're not doing a lot. They're kinda laying around. But but they they're still actually quite interactive right? Human brains are meant to be social detectors. Our brains are built from the very beginning. To detect social information information that's relevant to us. That's emotionally, socially important. And so not surprisingly moms faces are really important to babies, and so that babies should be attending to your face and the few smile there really should be some reciprocal smiling back and forth. So that's sort of an early really early signs to look for by twelve months than you should. Seeing some babbling in a lot of people get confused about this babbling is not a any sound, right. If it's not a shrieking sound. It's not a a just a repetitive. Sound babbling is like your child is speaking different language, a language that you don't know. But it sounds like a language, right? So if you go to France, and you don't know French. You know? That's what it sounds like. Right. It's it's it's like a language. So you should be seeing the babbling by twelve months. You should see a lot of back and forth gestures like pointing? Come here reaching waving showing things sharing these things should be there by twelve months in one of the earliest and most reliable signs in one that parents can really reliably pick up on is how the child response to their name. So around twelve months or even before twelve months you can call the child's name in they should respond. They should orient to their name. Right. Doesn't have to be a great response. It's not like they have to come running to you. But they should respond. They should be acknowledging that you're calling their name. Because by then they're they've associated this word their name with the interaction. And then as kids get older you wanna look for things. Like are they using single words? So by sixteen months, you should be seeing single words by twenty four months. They should be putting two words together or multiple word phrases together. In. In the as kids get older, you wanna look for other things too. Like, for example, if any age child seems to go backwards in their development. That's not a good song. Right. You wanna make sure you talk to the pediatrician about that? You can also sometimes see repetitive behaviors associated with autism as kids get older. So some examples of this even when kids are young you can see them sort of staring at objects water lights fans as they get older. You might see that they flap their hands or look out of their corner of their eye inflict their fingers of like I'm doing right now. So just sort of that idea of just looking at the corner of your eye instead of making good social contact. And then you can even see jumping in place spinning repetitively in other kinds of repetitive behaviors. Some kids with autism. But not all of them are less interested in social interaction. And this is very confusing. I'll still have parents or even some doctors who will say, I don't think this child has autism because they're really socially interested. Will it turns out that totally subset of kids? The that actually there's plenty of kids with autism. That are socially interested the province. They don't know how to do it. They don't know how to engage in the back and forth of social interaction. So those are kind of some of the early signs wanna look for obviously as kids get older, they should be more reciprocal their interaction. They should be looking at you exchanging, glances initiating pointing gesturing these kinds of social behaviors that we wanna see why would create that slip back that you that described. We don't exactly know what creates it. It's possible that in some kids there's what I would call a true neurological regression where. The child sort of had some skills, and then they lose these skills. So there may be as many as twenty percent of kids with autism that show some kind of behavioral or neurological regression like they might be speaking in then they stopped talking for either of several months, and then they start up again or some kids actually were talking maybe using simple words or two phrases in then they stop and they never start. Again. We don't know exactly why we do have some sense though. So for example, there's some kids that have seizure disorders epilepsy, and you can see the onset of those seizures around that time. And as a result of the seizures and some of the brain development that goes around seizures that can cause regression, but in other kids, we honestly don't know. I mean, my son regressed at about around twenty months, and you know, it was very confusing to us. We didn't know why he regressed. In he just sort of stopped talking in initiating with us in you know, eventually he did start talking a little bit again. But then they actually regressed back again. So, unfortunately, it can be very very scary for parents in in extremely difficult for folks to understand why is the job going forward, and then all of a sudden going backwards. Why does the I've heard a lot about screening or at least beginning intervention before the age of two and that being on the one hand very hard to identify with any certainty, but the signs you're describing are things that are really helpful for parents to sort of we observe our kids all the time for us to pay attention to and try to see early on. But what is it that happens before is it just brain plasticity that happens before to that? Really? Let's intervention take hold. And and and how does that early intervention really help children struggling through this? Well, a couple of things. So there's nothing, thankfully, there's nothing special about H two. Right. So really, it's the the actual mantras just earlier the better right now, obviously if you can initiate treatment at a little before or at age two that's fantastic. And there's even been some studies to suggest that if you can identify kids around fourteen or fifteen months, and you can start intervention then that you can really help those kids as well. So so yes, we do want to start as early as possible in in a we we try to get kids screened in eighteen twenty four months with the idea being that if they can get an early diagnosis, we can get them in around that age to Mark. But what really matters in the reason why early intervention is. So important is the earlier we are in our lives, the more. Our brain is plastic the more we can actually see our brain growth change in a positive direct drug should. So it is about plasticity. But the other thing to keep in mind. Here is that you know, if you're a parent who may be came to this a little later are blend. Our brains are still plastic. Our brains are plastic up through a dull hood, and so yes, we wanna get kids in early. We want early intervention, but you know, don't feel bad about identifying later just try to get the child into earth end intervention as soon as you can what am I think I think there's been a lot of talk about autism people are becoming more aware of it. But I think a lot of people are still confused at what it actually is. Because it is a spectrum because as you describe there are some kids who have completely different symptoms than others. And and I think it's confusing to people at especially as we watch our own kids grow up, and we want to we want to always be on high alert to anything that that they might deal with took. Can you just I mean, I know it's probably, you know, repetitive for you. But if you'll just sort of walk us through what is it that we're talking? About here. So a couple of things people should know. One is autism is an early developmental disorder. Right. And what I mean by that is in the vast majority of cases, autism brain development. The brain development that is contributing to the behavioral science, we call autism is starting very early in life for many kids. It probably starts in utero during pregnancy. Okay. So that's really important for people to understand is that we have evidence. Now that this is starting very very early in life for the for the majority of kids at least. But the I do agree with you people. Do get confused about what is autism. And I try to boil it down for folks because regardless of whether the child is very very bright or has a lot of cognitive difficulties. The core features of autism are still the same. And the two core. Features of autism are difficulty with understanding the social world how it works. Where should I be looking what what are the most important pieces of social emotional information in my world. So it's that social perception problem that is the first corps feature of autism. The second core. Feature of autism is getting stuck on things. Sometimes we call this inflexible a repetitive behaviors in like to just call it getting stuck because you can get stuck on a topic. Like, for example. I only wanna talk to you about train schedules, or I only wanna talk to you about Pokemon, right? I don't wanna talk about anything else. That's the only thing. I want to talk about right? So that's a case of what we call restricted interests where you're getting stuck on a particular topic or interest. But then there's also getting stuck on motor movements. So flapping your hands, for example or spinning in circles or twirling seeing how things dangle are looking at things out at the corner of your eye. This this is sort of getting stuck on repented motor movements in how things feel in the sensory experience of that. So these two core features understanding the social world in getting stuck on things really are the basic manifestation. Of what autism is. Now at a really high functioning person who's very cognitively able in brighter. Maybe even brilliant a lot of times. We'll we see we'll see problems with reciprocity of interaction. So I'll talk to you. But I won't make contact in a moment. Gonna talk to you about what I wanna talk about. And then you know, they're they're getting stuck behaviors they're repetitive. Behaviors are more about the restriction of interests. Or maybe I don't like it when the environment changes. Right. So I don't like it when mom wears a hat and sunglasses. For kids who have more cognitive difficulties. They may be non verbal or minimally verbal or maybe they have some language, but they also struggled with the reciprocal interaction. But they also sometimes just gonna struggle with basics skills. Like just being able to sit near somebody and allow that person to speak. They may have sensory issues that get them upset don't allow them to be in that environment. They're also gonna show poor high contact, but their context can be really bad, and they're not gonna be able to go back and forth, even one or two times. Right there. Reciprocity is going to be very very limited. They may actually have blatant communication problems. Like, they can't even communicate their once in needs. And then when you look at their repetitive behaviors they show a lot more of those repetitive. Sensory motor behaviors like my son's very low functioning. He has cognitive difficulties in he'll stare at something over and over again, that's dangling like he'll dangle a spider like a plastic spider or snake in he'll stare at that for literally hours, we allow to when people talk about the spectrum though, what they're really talking about is actually the cognitive spectrum. So they're talking about you can have people that are brilliant on one end of the spectrum, literally people that would be scientists engineers, you know, just amazing inventors and then on the other side of the spectrum, you have people that are, unfortunately, intellectually disabled and really struggle with even basic communication tasks. So that's really what people are talking about. When they talk about the spectrum. Now, you know, you talked about regression and how you saw that with your own son. I know as we are looking I all of all of us parents of young children as we're looking for, you know, signs of this to make sure that we can give the best possible care in life to our children. It is it looking back at your son's development in hindsight. Could you see signs earlier or was he a completely average child? And then and then all of a sudden started to regress seems completely everage. We did see some motor fine motor difficulties. He would he had trouble with pointing and fine motor is a common early feature, by the way that you see in his with autism. But but he was really actually very interactive. He would make I con. Ttacked he would try to engage in joint attention bids. He would even imitate me. I remember one time I was mowing the grass in the backyard, and he brought out his little more. He would MO next to me. So so he was even engaging in imitation. And then, you know, like sit around twenty months, he really regrets. So in some kids, you do see some signs early on in then they regress in other kids. They're fairly typical. And then you'll see the regression. So it does depend. And what will they there's no understanding of why that happens will there's there's I should say there's a little bit of understanding. So like I mentioned seizures epilepsy that can sometimes precipitated. The other thing that we think might be happening as our brain is pruning at that time, so very much like, pruning hedge, our brain is taking extra neurons because we have extra neurons in our brain when we're born in. It's taking the extra neurons that aren't being used in. It's it's getting rid of them. It's pruning them back. Okay. Because you don't wanna have all these extra neurons around the actually add noise to the signal. Right. And so you wanna print them back? Now the question is in autism. Do we see under? Pruning, or over pruning. In other words, is that process not working properly? And that may be part of the reason that we also see regression. It's it's a very difficult thing to study though, as you can imagine because the kids typically aren't diagnosed yet. Right. So it's very hard to study. But when people have tried to study, it number one that is a real phenomenon and. Number two, some of the kids with regression do show signs before the Russian not all of them. But some of them do show signs do you as a as a parent to your son with the kind of knowledge that you have and the end this sort of just deep expertise in this topic? Do you feel like there are things that you do differently as apparent that other parents with children with autism don't know about or would would that you could teach them to do differently? We'll probably my wife, I should mention his also board certified behavior analysts in works with autism. That's all I would say if my behavior is different. It's mostly because I learned from her. Goodness. But but I will say that parent training is crucial for people with caregivers of people with autism. In fact, the data's really clear if parents get trained in early developmental behavioral intervention approaches that the kids whose parents are trained do better in the long run than the kids, whose parents parents aren't trained. So yes, the answer is you do things differently than typical parenting obvious. It's not just about having patients. It's also about learning how to prompt in reinforce appropriate behaviors, you know, his parents allowed times we sort of sit back in weight and just hopefully the child's development, right? Hopefully, they're doing the right things in if they're not maybe we'll punish him or something. Will we don't wanna take that approach autism? But we wanna do is be much more active help our child to learn the right skill. So we prompt that skill right? We give them a directive in if they still don't follow the directive. We're gonna prompt them through it. And that the end of that of exhibiting that skill. We're going to reinforce it. And we're even going to reinforce a tempts. Right. So not just when they do it. Right. But actually just when they're trying to do it. Right. So we're going to reinforce them trying to do it. And then ultimately, we're trying to build those skills. Very active approach, not just a passive hands off approach. Can you give his walk us through an example of of that sort of interaction in practice? So in young kids, it might be actually teaching them the point, right? So you can actually help to shape their finger and show them how to point things, and then you can also sort of help them to look back at the caregiver because when you're engaging in pointing behavior it's not the appointing in just looking at the object, you're pointing at the object. And then you're looking back at your mom or dad to show them what you're pointing. Right. So you can actually prompt this you can show the child how to do it. And then you can show them how to look back, and then you can reward them for doing it like, you know, you can make sure that they know. That's a great job that they're doing you can reward them praise or you can even reward them with tangible rewards things that they like, you know, and as kids get older, another example would just be things like learning how to put on your shoes. So one of the things the reason why bring putting on your shoes is because a lot of times, we think of this as one behavior, but in actuality and can be like ten behaviors you have to go get the shoes. You've got a organiz make sure they're left shoes on the left. The right shoes on the right, then you've gotta pull up the tongue and make sure you put your foot incorrectly than you've got if there's if they're tie shoes, you've got to actually learn how to tie, you know, in different steps of for tying the shoes. Even if they're not tight shoes. You've gotta make sure you pull the tongue back again and make sure your foot not stuck on the back. So there's a lot of steps there in his parent's. We kinda treat that as if it's like one thing, you know, go go put on your shoes. But in with kids with autism. You wanna treat it like it's a series of steps, and you wanna prompt in reinforce those steps. So we can use. Is something called backward, chaining, where you actually prompt them through the whole process, and then you back off on the last step. And when they learned the last step, then you back off on the second last step and the third step until they have the whole behavior together. So this is like it's get parenting for for any for any threat is true. It actually is good parenting for any child. It's actually I always tell people not always a good parenting for any child. But my wife uses it on me as well. Garbage out on time. It's actually good behavior management for all human beings that sound funny. I had dinner the the other with my husband had a restaurant in a woman next to us was extraordinarily friendly. And and started offering us food and fraying, you know, talking to us, and she had just had a visit from her son who is now in his early twenties. And she told us that he's autistic, and I guess he goes to a a school up in Cape Cod. Some famous school for for autism up in Cape Cod. And she talked about how much I'm she there. There weren't the same resources. Now as there were when when her son was young, but she talks about how she looked into diet in terms of changing how he would behave that certain foods would would may help him or not help him in terms of sleep. She was very into homeopathy. Fee- is this is this something as well that you're finding so we don't have any evidence that special diets are helpful. But but I treat this very much like the behavior therapy. We just talked about if kids eat, well if the good diets, they do better, and that's especially true with the child with autism. Because obviously, their brains need even more careful attention, right? So if they're getting the right nutrients, if they're getting things that they body can use more effectively not so much sugar. You know being able to eat the right foods and be healthy. Then of course, that's good. Now, a lot of times people have looked at special nutrition's special diets sort of nutritional packages supplements things like that we don't have any evidence. Really yet. That's affective. There was one study this year using a whole cocktail of different approaches that suggested that there might be some value in this kind of special. Diet supplement approach, but with all science, you have to replicate things, right? You have to make sure it's replicated. So we don't want to recommend that kind of stuff to families until we've replicated that. But but nutrition is really interesting area for any child, but especially kids with autism. We do want to encourage more research and more science on diets nutrition. What about I know that this is a very tender subjects, but you know, I had a lot of people tell me where vaccines what has there been more research done, especially that I think is the MR that everybody gets very nervous about and I have to say when I do vaccinate my children, I spread them out. But every single time, I vaccinate my kids. I get nervous in. It's not unusual for parents of kids with autism to get nervous. Like, I have my son's fifteen in my daughter's fourteen, and we were very nervous about the. Meaning her, but the research in this case is pretty clear people have done Abidine meal logical. Studies large large studies, we we now have over hundreds of thousands of patients that have been studied kids that have been studied. And. Would they find is that the that that the kids who get a vaccination like MR are not greater risk for having autism than the kids who don't get the vaccination? So the research evidence all net is pretty clear that autism is not that vaccines aren't increasing the risk for autism. At the same time. You know, you're right. This is a very sensitive issue for people in one of the things that we say here is we want to respect people's experiences in at the same time as the society, it's really important that kids get their vaccines because if they don't get their vaccines. They can actually get really sick. And in some cases, die from diseases that we've been able to essentially radical especially in the west in. We don't wanna see kids tying. Right. I mean, that's terrible thing in there is such a thing called her immunity, which means that we all need to beginning. Our vaccines in order to make sure that all of us are protected right in. We don't wanna see large segments of the population not vaccinating because in that case, it can actually bring back the conditions that we've got rid of he lamb, you mentioned you have a daughter who's just a year younger than your son. What was there for families dealing with autism in a child and not having? At present in all of their kids. How do you how do you recommend they deal with that? Are there anything you said, you know, you were specifically aware for your daughter? But, but you know, how do you make sure my best friend in college? Her brother is is very low functioning autistic a little bit younger than her. But you know, now as a twenty seven year old twenty-eight-year-old, he's two hundred eighty pound six foot five I mean, it's a whole it's a very disruptive experience for the family, but it's also one whether they've come together around it too. So what what's what's your advice for families with multiple children dealing with dealing with this kind of? We'll for siblings, it is tough, especially if it's hard to for them to understand or connect with their sibling with autism. But I always encourage parents to educate their siblings. You know, let them know that this is the their siblings, not being a jerk or you know, it's not that they're being mean that actually that there's problems with appropriately interacting and communicating. And luckily, I think there's something that happens in autism was siblings that is a real positive here. And that's that the siblings do tend to learn this pretty quickly, and ultimately many of the siblings. Become just amazing people, you know, really empathetic people many of these folks go into developmental areas. Whether it's teaching or therapy advocacy, support services, and to be honest like over the years, some of our best therapist for my son were were. Siblings of who had you know, brother or sister with autism in. So, you know, if there is an upside here, it's really that the siblings oftentimes do adjust well in actually can be tremendous advocates in therapists in do wonderful things and the other part about autism that I think helps other family members is that it can't give you a sense of meaning in purpose. You know, it's tear in oftentimes, it's very difficult to watch your family member struggle, obviously. But at the same time for me, it gave me a purpose to give me a sense of Ocalan help my slump. I'm gonna I'm gonna be there for him. I'm gonna try to make his life better and people like my son, I wanna make their life better too. So it isn't all negative, right? Mean you can find the positives in these situations in for higher functioning people with autism. What we're seeing too is that they can be great advocates. You know, they can really be. Incredible. People that push for better, better rights better services. Better supports better awareness understanding and acceptance, and you know, that's fantastic as well. Were you in this field before your son was diagnosed I was a clinical psychologist, and I was studying kids, but I wasn't in autism. And then when my son was diagnosed, I shifted my career into autism in in. That's what my wife got her BC CBA, and she started to work with people with autism. And so we kind of have made autism are our sort of family mission. But at the perfect of what we were just talking about. It's like, okay. You know, here's the problem. I'm gonna make the world better place in turning this into a major positive. What are some of what are some of the therapies just because you both live and breathe. This what are some of the therapies that you fo